Branco Ricardo G, Tasker Robert C
Department of Paediatrics, University of Cambridge School of Medicine, Addenbrookes Hospital, Cambridge, UK.
Pediatr Crit Care Med. 2007 Nov;8(6):546-50. doi: 10.1097/01.PCC.0000288712.67749.45.
To evaluate in children with bronchiolitis requiring mechanical ventilation the association between blood glucose level and duration of mechanical ventilation and pediatric intensive care unit (PICU) stay.
Retrospective cohort study.
University hospital PICU.
Children admitted to a university hospital PICU over a period of 3 yrs.
None.
Demographic data, infection with respiratory syncytial virus, history of prematurity, mechanical ventilator settings, and use of inotrope during illness were noted. In addition, C-reactive protein, alanine transaminase, and glucose levels were recorded. Data from 50 children with median (interquartile range) age of 2.2 (1.3-4.7) months were analyzed. There were 37 boys, 21 children had been premature babies, and 30 children were positive for respiratory syncytial virus. Hyperglycemia at any time was frequent (peak glucose > or =6.1 mmol/L [110 mg/dL] in 98% and >8.3 mmol/L [150 mg/dL] in 72%). Children with sustained hyperglycemia were more likely to be boys with higher alanine transaminase and C-reactive protein, requiring inotrope (p < .05). These children are more likely to have required high-frequency oscillation ventilation, required higher airway pressures, and had longer duration of mechanical ventilation and PICU stay (p < .05). Peak glucose and sustained peak glucose were not independently associated with duration of mechanical ventilation or PICU stay. Multiple regression showed that age, C-reactive protein, the need for inotrope, and respiratory syncytial virus infection were independent factors associated with duration of PICU stay. Glucose level was not a factor.
Our findings show that hyperglycemia is frequent in children with bronchiolitis requiring mechanical ventilation, but we failed to show that this phenomenon was independently associated with prolonged duration of mechanical ventilation or PICU stay. Our observations raise the question whether tight glycemic control should be used in children with bronchiolitis.
评估需要机械通气的毛细支气管炎患儿血糖水平与机械通气时间及儿科重症监护病房（PICU）住院时间之间的关联。
回顾性队列研究。
大学医院PICU。
3年内入住大学医院PICU的患儿。
无。
记录人口统计学数据、呼吸道合胞病毒感染情况、早产史、机械通气设置以及患病期间使用血管活性药物的情况。此外，记录C反应蛋白、丙氨酸转氨酶和血糖水平。分析了50名年龄中位数（四分位间距）为2.2（1.3 - 4.7）个月的患儿的数据。其中有37名男孩，21名患儿为早产儿，30名患儿呼吸道合胞病毒检测呈阳性。随时出现的高血糖很常见（血糖峰值≥6.1 mmol/L [110 mg/dL] 的患儿占98%，≥8.3 mmol/L [150 mg/dL] 的患儿占72%）。持续性高血糖的患儿更可能是男孩，丙氨酸转氨酶和C反应蛋白水平较高，需要使用血管活性药物（p < 0.05）。这些患儿更可能需要高频振荡通气，需要更高的气道压力，机械通气时间和PICU住院时间更长（p < 0.05）。血糖峰值和持续性血糖峰值与机械通气时间或PICU住院时间无独立关联。多元回归分析显示，年龄、C反应蛋白、是否需要使用血管活性药物以及呼吸道合胞病毒感染是与PICU住院时间相关的独立因素。血糖水平不是一个因素。
我们的研究结果表明，需要机械通气的毛细支气管炎患儿中高血糖很常见，但我们未能证明这种现象与机械通气时间延长或PICU住院时间延长独立相关。我们的观察结果提出了一个问题，即毛细支气管炎患儿是否应进行严格的血糖控制。
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