Pediatric Critical Illness Hyperglycemia: Risk Factors Associated with Development and Severity of Hyperglycemia in Critically Ill Children

Abstract

To determine which children are susceptible to critical illness hyperglycemia (CIH) and whether CIH severity and duration correlate with diagnosis or illness severity. We developed a standard approach to identify and treat CIH in our medical/surgical pediatric intensive care unit. We define CIH as persistent blood glucose (BG) >140 mg/dL and titrate infused insulin to maintain BG 80 to 140 mg/dL. We conducted a retrospective analysis of patients with hyperglycemia from June 2006 through May 2007. Main outcomes were risk of development of CIH in different patient subgroups and CIH severity and duration. Average peak BG, CIH duration, and peak insulin requirements were 199 mg/dL, 6.3 days, and 0.09 units/kg/h, respectively, in patients with CIH. CIH severity and duration were highest in neurosurgical and patients with sepsis, those requiring mechanical ventilation and vasopressors, extracorporeal support, and those with highest illness severity scores. CIH severity and duration correlate with diagnosis and illness severity. Certain "risk factors" may be predictive of who develops CIH.