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Hyperglycemia, Dysglycemia and Glycemic Control in Pediatric Critical Care

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Pediatric Critical Care Medicine

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Abstract

Although once considered a benign consequence to the stress of severe illness or injury, a significant body of evidence compiled over the past decade shows that hyperglycemia in critically ill patients is associated with poor outcomes. In both adults and pediatric studies, there is a strong association with hyperglycemia with higher morbidity and mortality, and in some prospective studies, controlling hyperglycemia improves outcomes. These data have resulted in a number of national and international consensus statements and guidelines recommending active glycemic control – though primarily directed at the critically ill or injured adult. Due to the lack of pediatric-specific data, it has been unclear how pediatric intensivists should incorporate glycemic control into their practice. During the past decade data from both retrospective and prospective studies have also shown significant associations between hypoglycemia and dysglycemia (i.e., glycemic variability) and poor outcomes. From the current data, it appears that both hyper- and hypoglycemia occurs in patients who have higher illness severities and require more organ support measures. A number of pediatric-specific protocols have been developed and published which suggest that approaches to identify and manage hyperglycemia in critically ill children can be effectively and safely implemented, and interestingly in many cases hypoglycemic rates are less than that which occurs spontaneously. Although most pediatric practitioners support active glycemic control in certain subsets of patients, it is unclear how widespread standardized, consistent glycemic management has been incorporated into practice. Prospective trials have yielded disparate outcome findings regarding glycemic control in the pediatric ICU. Data from ongoing and completed studies will hopefully yield more definitive data on whether pediatric practitioners should regularly practice glycemic control, and what patient populations might benefit from this practice. This chapter reviews the existing data on hyperglycemia, hypoglycemia and dysglycemia, and will hopefully assist how pediatric practitioners synthesize these data into practice.

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Authors and Affiliations

  1. Department of Medicine, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA

    Michael S. D. Agus MD

  2. Department of Pediatrics, Yale School of Medicine, 333 Cedar Street, N/A, New Haven, CT, 06520, USA

    Edward Vincent S. Faustino MD

  3. Department of Pediatrics, Indiana University School of Medicine and Riley Hospital for Children, 705 Riley Hospital Drive, Indianapolis, IN, 46202, USA

    Mark R. Rigby MD, PhD, FAAP, FCCM

Authors
  1. Michael S. D. Agus MD
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  2. Edward Vincent S. Faustino MD
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  3. Mark R. Rigby MD, PhD, FAAP, FCCM
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Corresponding author

Correspondence to Mark R. Rigby MD, PhD, FAAP, FCCM .

Editor information

Editors and Affiliations

  1. Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA

    Derek S. Wheeler

  2. Div. of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA

    Hector R. Wong

  3. MICHR, University of Michigan Medical Scho, Ann Arbor, Michigan, USA

    Thomas P. Shanley

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Agus, M.S.D., Faustino, E.V.S., Rigby, M.R. (2014). Hyperglycemia, Dysglycemia and Glycemic Control in Pediatric Critical Care. In: Wheeler, D., Wong, H., Shanley, T. (eds) Pediatric Critical Care Medicine. Springer, London. https://doi.org/10.1007/978-1-4471-6416-6_8

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  • DOI: https://doi.org/10.1007/978-1-4471-6416-6_8

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