Medical Center of Central Georgia, Department of Pediatrics, Division of Pediatric Critical Care Medicine, 777 Hemlock Street, Macon, Georgia, 31201, USA.
Crit Care. 2010;14(1):R11. doi: 10.1186/cc8865. Epub 2010 Feb 3.
Hyperglycemia is common in critically ill patients and is associated with increased morbidity and mortality. Strict glycemic control improves outcomes in some adult populations and may have similar effects in children. While glycemic control has become standard care in adults, little is known regarding hyperglycemia management strategies used by pediatric critical care practitioners. We sought to assess both the beliefs and practice habits regarding glycemic control in pediatric intensive care units (ICUs) in the United States (US).
We surveyed 30 US pediatric ICUs from January to May 2009. Surveys were conducted by phone between the investigators and participating centers and consisted of a 22-point questionnaire devised to assess physician perceptions and center-specific management strategies regarding glycemic control.
ICUs included a cross section of centers throughout the US. Fourteen out of 30 centers believe all critically ill hyperglycemic adults should be treated, while 3/30 believe all critically ill children should be treated. Twenty-nine of 30 believe some subsets of adults with hyperglycemia should be treated, while 20/30 believe some subsets of children should receive glycemic control. A total of 70%, 73%, 80%, 27%, and 40% of centers believe hyperglycemia adversely affects outcomes in cardiac, trauma, traumatic brain injury, general medical, and general surgical pediatric patients, respectively. However, only six centers use a standard, uniform approach to treat hyperglycemia at their institution. Sixty percent of centers believe hypoglycemia is more dangerous than hyperglycemia. Seventy percent listed fear of management-induced hypoglycemia as a barrier to glycemic control at their center.
Considerable disparity exists between physician beliefs and actual practice habits regarding glycemic control among pediatric practitioners, with few centers reporting the use of any consistent standard approach to screening and management. Physicians wishing to practice glycemic control in their critically ill pediatric patients may want to consider adopting center-wide uniform approaches to improve safety and efficacy of treatment.
危重病患者常出现高血糖，且与发病率和死亡率升高相关。严格血糖控制可改善某些成年患者的预后，在儿童中可能也有类似效果。成人血糖控制已成为标准治疗方法，但儿科重症监护医生使用的高血糖管理策略知之甚少。我们旨在评估美国儿科重症监护病房（PICU）中血糖控制的信念和实践习惯。
我们于 2009 年 1 月至 5 月调查了美国的 30 家儿科 ICU。调查由研究者与参与中心之间通过电话进行，调查问卷由 22 个问题组成，旨在评估医生对血糖控制的看法和中心特定的管理策略。
所纳入的 ICU 代表了美国各地的中心。14/30 的中心认为所有危重病高血糖成人都应接受治疗，而 3/30 的中心认为所有危重病儿童都应接受治疗。29/30 的中心认为应治疗某些成人亚组的高血糖，而 20/30 的中心认为某些儿童亚组应接受血糖控制。共有 70%、73%、80%、27%和 40%的中心认为高血糖分别对心脏、创伤、创伤性脑损伤、普通内科和普通外科儿科患者的结局有不利影响。然而，仅有 6 家中心在其机构中使用标准、统一的方法来治疗高血糖。60%的中心认为低血糖比高血糖更危险。70%的中心列出了担心管理引起的低血糖是其中心血糖控制的障碍。
儿科医生在血糖控制方面的信念和实际实践习惯之间存在相当大的差异，很少有中心报告使用任何一致的标准方法进行筛查和管理。希望在其危重病儿科患者中进行血糖控制的医生可能希望考虑采用中心范围内的统一方法，以提高治疗的安全性和有效性。
