Feature ArticleContinuing Medical Education

Association of timing, duration, and intensity of hyperglycemiawith intensive care unit mortality in critically ill children

Vijay Srinivasan, MD; Philip C. Spinella, MD, FAAP; Henry R. Drott, PhD; Carey L. Roth, EdD(c), RN;Mark A. Helfaer, MD, FCCM; Vinay Nadkarni, MD, FAAP, FCCM

Clinical Fellow, Pediatric Critical Care Medicine, TheChildrens Hospital of Philadelphia, Division of CriticalCare Medicine, Philadelphia, PA (VS); Assistant Professor,Department of Pediatrics, Uniformed Services Universityof Health Sciences, San Antonio, TX (PCS); Director, Clin-ical Chemistry, The Childrens Hospital of Philadelphia,Clinical Assistant Professor, Department of Pediatrics,University of Pennsylvania, Philadelphia, PA (HRD); Coor-dinator of Critical Care Research, The Childrens Hospital

of Philadelphia, Philadelphia, PA (CLR); Professor of An-esthesia, Pediatrics and Critical Care Medicine, The Chil-drens Hospital of Philadelphia, Department of Anesthesia& Critical Care Medicine, Philadelphia, PA (MAH); andAssociate Professor, Department of Anesthesia and Pe-diatrics, University of Pennsylvania School of Medicine,The Childrens Hospital of Philadelphia, Department ofAnesthesia and Critical Care Medicine, Philadelphia, PA(VN).

Supported, in part, by the Endowed Chair, CriticalCare Medicine, The Childrens Hospital of Philadelphia(MAH).

Copyright 2004 by the Society of Critical CareMedicine and the World Federation of Pediatric Inten-sive and Critical Care Societies

DOI: 10.1097/01.PCC.0000128607.68261.7C

LEARNING OBJECTIVES

On completion of this article, the reader should be able to:

1. Recall the diseases in critically ill adults and children in which hyperglycemia is associated with a poor outcome.

2. Identify that both peak blood glucose level and duration of hyperglycemia are associated with increased risk of mortalityin critically ill children.

3. Identify potential biological mechanisms by which hyperglycemia can be detrimental in critically ill infants and children.

The authors have disclosed that they have no financial relationship with commercial companies pertaining to thiseducational activity.

Visit the Pediatric Critical Care Medicine Online website (www.pccmjournal.com) for information on obtaining continuingmedical education credit.

Objective: To study the association of timing, duration, andintensity of hyperglycemia with pediatric intensive care unit(PICU) mortality in critically ill children.

Design: Retrospective cohort study.Setting: PICU of a university-affiliated, tertiary care, childrens

hospital.Patients: A total of 152 critically ill children receiving vasoac-

tive infusions or mechanical ventilation.Interventions: None.Methods: With institutional review board approval, we re-

viewed a cohort of 179 consecutive children, 1 mo to 21 yrs ofage, treated with mechanical ventilation or vasoactive infusions.We excluded 18 with 126 mg/dL), and intensity of hyperglycemia(median BG during first 48 PICU hours) were analyzed for asso-ciation with PICU mortality using chi-square, Students t-test, andlogistic regression.

Measurements and Main Results: Peak BG of >126 mg/dLoccurred in 86% of patients. Compared with survivors, nonsurvi-

vors had higher peak BG (311 115 vs. 205 80 mg/dL, p