Published online September 8, 2008
PEDIATRICS Vol. 122 No. 4 October 2008, pp. e898-e904 (doi:10.1542/10.1542/peds.2008-0871)

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ARTICLE

Strict Glycemic Targets Need Not Be So Strict: A More Permissive Glycemic Range for Critically Ill Children

Kalia Patricia Ulate, MD^a, Germano Correia Lima Falcao, MD^a, Mark Richard Bielefeld, MD^b, John Mark Morales, MD^b and Alexandre Tellechea Rotta, MD, FCCM, FAAP^c,d

^a Departments of Pediatrics
^b Cardiovascular Surgery
^c Anesthesiology and Critical Care, Driscoll Children's Hospital, Corpus Christi, Texas
^d Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas

OBJECTIVE. The goal was to determine whether a more permissive glycemic target would be associated with a decreased incidence of hypoglycemia but not increased mortality rates in critically ill pediatric patients.

METHODS. This retrospective study evaluated clinical and laboratory data for 177 patients who underwent 211 consecutive surgical procedures for repair or palliation of congenital heart defects at Driscoll Children's Hospital. To establish the relationship between postoperative glycemia and subsequent morbidity and mortality rates, patients were stratified into 4 groups according to their median glucose levels, that is, euglycemia (60–125 mg/dL, 3.3–6.9 mmol/L), mild hyperglycemia (126–139 mg/dL, 6.9–7.7 mmol/L), moderate hyperglycemia (140–179 mg/dL, 7.7–9.9 mmol/L), or severe hyperglycemia (180 mg/dL, 9.9 mmol/L). Postoperative outcomes for those groups also were compared with outcomes for a more permissive glycemic target group (90–140 mg/dL, 5–7.7 mmol/L).

RESULTS. The peak and mean blood glucose measurements and duration of hyperglycemia were not different for survivors and nonsurvivors in the first 24 hours after surgery. Nonsurvivors had higher peak glucose levels (389.3 ± 162 mg/dL vs 274.4 ± 106.3 mg/dL, 21.4 ± 8.9 mmol/L vs 15.1 ± 5.9 mmol/L) and longer duration of hyperglycemia (3.06 ± 1.67 days vs 2.11 ± 0.92 days) during the first 5 postoperative days, compared with survivors. Mortality rates were significantly higher for the moderate (38.8%) and severe (58.3%) hyperglycemia groups, compared with the euglycemia (6.02%) and permissive target (4.69%) groups. The incidence of hypoglycemia was significantly higher in the euglycemia group (31.8%), compared with the permissive target group (17.18%).

CONCLUSIONS. Postoperative hyperglycemia is associated with increased morbidity and mortality rates in children after surgical repair of congenital heart defects. A more permissive glycemic target is associated with a lower incidence of hypoglycemia but not increased mortality rates in these patients.

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Key Words: hyperglycemia • hypoglycemia • congenital heart defects • postoperative care • children • intensive care • mortality • morbidity

Abbreviations: RACHS-1—Risk Adjustment for Congenital Heart Surgery • CPB—cardiopulmonary bypass

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Accepted Jun 4, 2008.

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