Glucose control in the pediatric intensive care unit: More questions than answers!

摘要

Tight glucose control has emerged as a promising but unproven therapy to improve outcomes of critical illness in adults and children. After the landmark study (1) from Belgium reported remarkable improvements in mortality and morbidity with tight glucose control in critically ill adults, subsequent studies (2-5) from across the world have had mixed results, with some studies observing worse outcomes with tight glucose control in critically ill adults. Furthermore, all these studies observed huge increases in hypoglycemia with tight glucose control. These contrasting results may be attributable to disparities in patient populations, differences in glycemic targets and glucose control protocols, variability in attaining these targets, differences in nutrition protocols, variable sampling and measurement techniques, and variable expertise in protocol implementation (6). Consequently, the initial enthusiasm to embrace this therapy has justifiably given way to a more cautious approach in the adult critical care community.