Short-Term Adverse Outcomes Associated With Hypoglycemia in Critically Ill Children

被引：7

作者：

Faustino, Edward Vincent S. ^{[1
]}

Hirshberg, Eliotte L. ^{[2
]}

Asaro, Lisa A. ^{[3
,13
]}

Biagas, Katherine V. ^{[4
,5
]}

Pinto, Neethi ^{[6
,35
]}

Srinivasan, Vijay ^{[7
,8
,14
]}

Bagdure, Dayanand N. ^{[9
]}

Steil, Garry M. ^{[10
]}

Coughlin-Wells, Kerry ^{[10
]}

Wypij, David ^{[3
,11
,12
,13
]}

Nadkarni, Vinay M. ^{[7
,8
]}

Agus, Michael S. D. ^{[10
,12
]}

Agus, Michael ^{[13
]}

Wypij, David ^{[3
,11
,12
,13
]}

Asaro, Lisa

Nadkarni, Vinay ^{[14
]}

Srinivasan, Vijay ^{[7
,8
,14
]}

Biagas, Katherine ^{[15
]}

Mourani, Peter M. ^{[16
]}

Chima, Ranjit ^{[17
]}

Thomas, Neal J. ^{[18
]}

Li, Simon ^{[19
]}

Pinto, Alan ^{[19
]}

Newth, Christopher ^{[20
]}

Hassinger, Amanda ^{[21
]}

Bysani, Kris ^{[22
]}

Rehder, Kyle J. ^{[23
]}

Faustino, Edward Vincent ^{[24
]}

Kandil, Sarah ^{[24
]}

Hirshberg, Eliotte ^{[25
]}

Wintergerst, Kupper ^{[26
]}

Schwarz, Adam ^{[27
]}

Bagdure, Dayanand ^{[28
]}

Marsillio, Lauren ^{[29
]}

Cvijanovich, Natalie ^{[30
]}

Nga Pham ^{[31
]}

Quasney, Michael ^{[32
]}

Flori, Heidi ^{[32
]}

Federman, Myke ^{[33
]}

Nett, Sholeen ^{[34
]}

Pinto, Neethi ^{[6
,35
]}

Viteri, Shirley ^{[36
]}

Schneider, James ^{[37
]}

Medar, Shivanand ^{[38
]}

Sapru, Anil ^{[39
]}

McQuillen, Patrick ^{[39
]}

Babbitt, Christopher ^{[40
]}

Lin, John C. ^{[41
]}

Jouvet, Philippe ^{[42
]}

Yanay, Ofer ^{[43
]}

机构：

[1] Yale Sch Med, Dept Pediat, New Haven, CT 06510 USA

[2] Univ Utah, Intermountain Med Ctr, Dept Med, Div Pulm & Crit Care, Murray, UT USA

[3] Boston Childrens Hosp, Dept Cardiol, Boston, MA USA

[4] Columbia Univ, Dept Pediat, Med Ctr, New York, NY 10027 USA

[5] Morgan Stanley Childrens Hosp, New York, NY USA

[6] Univ Chicago, UChicago Med Comer Childrens Hosp, Dept Pediat, Chicago, IL 60637 USA

[7] Childrens Hosp Philadelphia, Dept Anesthesiol & Crit Care Med, Philadelphia, PA 19104 USA

[8] Univ Penn, Perelman Sch Med, Dept Anesthesiol & Crit Care, Philadelphia, PA 19104 USA

[9] Univ Maryland, Sch Med, Dept Pediat, Baltimore, MD 21201 USA

[10] Boston Childrens Hosp, Dept Pediat, Div Med Crit Care, Boston, MA USA

[11] Harvard TH Chan Sch Publ Hlth, Dept Biostat, Boston, MA USA

[12] Harvard Med Sch, Dept Pediat, Boston, MA 02115 USA

[13] Boston Childrens Hosp, Boston, MA USA

[14] Univ Penn, Perelman Sch Med, Childrens Hosp Philadelphia, Philadelphia, PA 19104 USA

[15] Columbia Univ, Med Ctr, Coll Physicians & Surg, New York, NY USA

[16] Univ Colorado, Sch Med, Childrens Hosp Colorado, Aurora, CO USA

[17] Univ Cincinnati, Coll Med, Cincinnati Childrens Hosp Med Ctr, Cincinnati, OH USA

[18] Penn State Coll Med, Penn State Hershey Childrens Hosp, Hershey, PA USA

[19] Maria Fareri Childrens Hosp, Westchester Med Ctr, Valhalla, NY USA

[20] Keck Sch Med USC, Childrens Hosp Los Angeles, Los Angeles, CA USA

[21] SUNY Buffalo, Sch Med, John R Oishei Childrens Hosp, Buffalo, NY USA

[22] Med City Childrens Hosp, Dallas, TX USA

[23] Duke Univ, Sch Med, Duke Childrens Hosp & Hlth Ctr, Durham, NC USA

[24] Yale New Haven Childrens Hosp, Yale Sch Med, New Haven, CT USA

[25] Univ Utah, Sch Med, Intermountain Med Ctr, Salt Lake City, UT USA

[26] Univ Louisville, Sch Med, Norton Childrens Hosp, Louisville, KY 40292 USA

[27] Univ Calif Irvine, Childrens Hosp Orange Cty, Sch Med, Orange, CA 92668 USA

[28] Univ Maryland, Med Ctr, Sch Med, Baltimore, MD 21201 USA

[29] Northwestern Univ, Feinberg Sch Med, Ann & Robert H Lurie Childrens Hosp Chicago, Chicago, IL 60611 USA

[30] UCSF Sch Med, UCSF Benioff Childrens Hosp, Oakland, CA USA

[31] Emory Univ, Sch Med, Childrens Healthcare Atlanta, Atlanta, GA USA

[32] Univ Michigan, Med Sch, CS Mott Childrens Hosp, Ann Arbor, MI 48109 USA

[33] Univ Calif Los Angeles, David Geffen Sch Med, Mattel Childrens Hosp, Los Angeles, CA 90095 USA

[34] Geisel Sch Med Dartmouth, Dartmouth Hitchcock Med Ctr, Lebanon, NH USA

[35] Univ Chicago, Pritzker Sch Med, Comer Childrens Hosp, Chicago, IL 60637 USA

[36] TJU, Sidney Kimmel Med Coll, Nemours Alfred I duPont Hosp Children, Wilmington, DE USA

[37] Hofstra Northwell Sch Med, Cohen Childrens Med Ctr NY, New Hyde Pk, NY USA

[38] Albert Einstein Coll Med, Childrens Hosp Montefiore, Bronx, NY 10467 USA

[39] UCSF Sch Med, UCSF Benioff Childrens Hosp, San Francisco, CA USA

[40] Univ Calif Irvine, Med Sch, Miller Women & Childrens Hosp, Long Beach, CA USA

[41] Washington Univ, St Louis Childrens Hosp, Sch Med, St Louis, MO 63110 USA

[42] Univ Montreal, Fac Med, CHU St Justine, Montreal, PQ, Canada

[43] Univ Washington, Sch Med, Seattle Childrens Hosp, Seattle, WA USA

[44] Univ Oklahoma, Coll Med, Childrens Hosp Oklahoma, Oklahoma City, OK 73190 USA

来源：

CRITICAL CARE MEDICINE | 2019年 / 47卷 / 05期

基金：

美国国家卫生研究院;

关键词：

continuous glucose monitor; glucose; glycemic control; hyperglycemia; intensive care unit; pediatrics; TIGHT GLYCEMIC CONTROL; GLUCOSE VARIABILITY; PEDIATRIC-PATIENTS; ORGAN DYSFUNCTION; BLOOD-GLUCOSE; MORTALITY; CARE; HYPERGLYCEMIA; RISK; HOMEOSTASIS;

D O I：

10.1097/CCM.0000000000003699

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Objectives: Previous studies report worse short-term outcomes with hypoglycemia in critically ill children. These studies relied on intermittent blood glucose measurements, which may have -introduced detection bias. We analyzed data from the Heart And Lung Failure-Pediatric INsulin Titration trial to determine the association of hypoglycemia with adverse short-term outcomes in critically ill children. Design: Nested case-control study. Setting: Thirty-five PICUs. A computerized algorithm that guided the timing of blood glucose measurements and titration of insulin infusion, continuous glucose monitors, and standardized glucose infusion rates were used to minimize hypoglycemia. Patients: Nondiabetic children with cardiovascular and/or respiratory failure and hyperglycemia. Cases were children with any hypoglycemia (blood glucose < 60 mg/dL), whereas controls were children without hypoglycemia. Each case was matched with up to four unique controls according to age group, study day, and severity of illness. Interventions: None. Measurements and Main Results: A total of 112 (16.0%) of 698 children who received the Heart And Lung Failure-Pediatric INsulin Titration protocol developed hypoglycemia, including 25 (3.6%) who developed severe hypoglycemia (blood glucose < 40 mg/dL). Of these, 110 cases were matched to 427 controls. Hypoglycemia was associated with fewer ICU-free days (median, 15.3 vs 20.2 d; p = 0.04) and fewer hospital-free days (0 vs 7 d; p = 0.01) through day 28. Ventilator-free days through day 28 and mortality at 28 and 90 days did not differ between groups. More children with insulin-induced versus noninsulin-induced hypoglycemia had zero ICU-free days (35.8% vs 20.9%; p = 0.008). Outcomes did not differ between children with severe versus nonsevere hypoglycemia or those with recurrent versus isolated hypoglycemia. Conclusions: When a computerized algorithm, continuous glucose monitors and standardized glucose infusion rates were used to manage hyperglycemia in critically ill children with cardiovascular and/or respiratory failure, severe hypoglycemia (blood glucose < 40 mg/ dL) was uncommon, but any hypoglycemia ( blood glucose < 60 mg/ dL) remained common and was associated with worse short-term outcomes.

引用

页码：706 / 714

页数：9

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