Should Hyperglycemia in Critically Ill Children Be Treated?

Détails

ID Serval
serval:BIB_2AAC1B31EB0F
Type
Actes de conférence (partie): contribution originale à la littérature scientifique, publiée à l'occasion de conférences scientifiques, dans un ouvrage de compte-rendu (proceedings), ou dans l'édition spéciale d'un journal reconnu (conference proceedings).
Sous-type
Abstract (résumé de présentation): article court qui reprend les éléments essentiels présentés à l'occasion d'une conférence scientifique dans un poster ou lors d'une intervention orale.
Collection
Publications
Titre
Should Hyperglycemia in Critically Ill Children Be Treated?
Titre de la conférence
5th World Congress on Pediatric Critical Care
Auteur(s)
Perez M.H., Racine-Parret L., Di Bernardo S., Stucki P., Cotting J.
Adresse
Geneva, Switzerland, June 24-28, 2007
ISBN
1529-7535
Statut éditorial
Publié
Date de publication
2007
Peer-reviewed
Oui
Volume
8
Série
Pediatric Critical Care Medicine
Pages
A293
Langue
anglais
Résumé
Introduction: In adults, strict control of hyperglycemia reduces
mortality and morbidity. There is controversy in medical patients
and neurological patients who can suffer of neuroglucopenia.
Objectives: To determine prevalence and prognostic significance
of hyperglycemia among critically ill non-diabetic children.
To evaluate which patients will best benefit of insulin
treatment.
Methods: Retrospective study using blood glucose levels
(GLUC: 9015 values, 923 patients) in our PICU from 01.2003
to 12.2005. 11 Patients with DKA were excluded. Overall
PICU mortality was 3.7%. Hyperglycemia was defined at 6.1
mmol/L and different cutoff values (6.1, 8.3 and 11.1 mmol/l)
were analyzed for glycemia at admission (GLUC). Sustained
hyperglycemia was evaluated with the area under the curve
normalized per hour (48h-AUC/h) for the first 48 h. The prevalence
of hypo (_3mmol/L), hyperglycemia and PICU death
were analyzed.
Results: Trough the use of different cutoff values (_6.1, _8.3 and
_11.1 mmol/l), prevalence of hyperglycemia at admission was 31.8
%, 16.8% and 10.3%; associated mortality was 2.8%, 4.0% and
15.2% respectively, significantly correlated to cutoff values (r_0.95,
p_0.05). Prevalence of hypoglycemia at admission was low (0.9%
with no death). 48h-AUC(mmol/L/h) was computed in 747 children
(30 deaths). Prevalence of hyperglycemic 48h-AUC values was
47.5%, 17.3% and 4.0% with a respective mortality of 3.4%, 6.3%
and 20.7% (r_0.97, p_0.03). For those with high GLUC and high
48h-AUC (_ 11.1 mmol/L) mortality was high (31.5%), but it decrease
dramatically to 5.5% when 48h-AUC decrease spontaneously
to values _8.3 mmol/L/h. Finally, when patients with severe
neurological lesions (GCS_3, n_22) where excluded, increased
mortality was observed only for GLUC (n_ 86) and 48h-AUC
(n_26) higher than 11.1 mmol/L.
Conclusions: Hyperglycemia at admission and even more sustained
hyperglycemia (AUC) are highly correlated to mortality in
PICU. But children who will have benefit of insulin therapy represent
only 3% of our population, much lower than for adults.
Création de la notice
22/10/2010 14:23
Dernière modification de la notice
03/03/2018 15:23
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