Lou Song, MacLaren Graeme, Paul Eldho, Best Derek, Delzoppo Carmel, Butt Warwick
1Paediatric Intensive Care Unit, The Royal Children's Hospital, Melbourne, VIC, Australia. 2Department of Cardiopulmonary Bypass, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China. 3Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia. 4Cardiothoracic Intensive Care Unit, National University Health System, Singapore. 5School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
Pediatr Crit Care Med. 2015 Mar;16(3):270-5. doi: 10.1097/PCC.0000000000000304.
To evaluate the relationship between glucose derangement, insulin administration, and mortality among children on extracorporeal membrane oxygenation.
Retrospective cohort.
Tertiary PICU.
Two hundred nine children receiving extracorporeal membrane oxygenation, including 97 neonates.
None.
Hyperglycemia and severe hyperglycemia were defined as a single blood glucose level greater than 15 mmol/L (270 mg/dL) and greater than 20 mmol/L (360 mg/dL), respectively. Hypoglycemia and severe hypoglycemia were defined as any single glucose level less than 3.3 mmol/L (60 mg/dL) and less than 2.2 mmol/L (40 mg/dL), respectively. A total of 15,912 glucose values were recorded. The median number of glucose values was 59 per patient, corresponding to a mean 0.53 ± 0.12 tests per hour. Sixty-nine patients (33.0%) without dysglycemia and who received no insulin were defined as the control group. Eighty-nine (42.6%) and 26 (12.4%) patients developed hyperglycemia and severe hyperglycemia, respectively. Sixty-three (30.1%) and 17 (8.1%) patients developed hypoglycemia and severe hypoglycemia, respectively. Sixty-one patients (29.2%) received IV insulin during extracorporeal membrane oxygenation. Both hyperglycemia and hypoglycemia were associated with increased mortality on extracorporeal membrane oxygenation (46% and 48%, respectively, vs 29% of controls; p = 0.03). However, after adjusting for severity of illness and extracorporeal membrane oxygenation complications, abnormal glucose levels were not independently related to mortality.
Dysglycemia in children on extracorporeal membrane oxygenation was common but not independently associated with increased mortality. The optimal glucose range for this high-risk population requires further investigation.
评估接受体外膜肺氧合治疗的儿童血糖紊乱、胰岛素使用与死亡率之间的关系。
回顾性队列研究。
三级儿科重症监护病房。
209例接受体外膜肺氧合治疗的儿童，其中包括97例新生儿。
无。
高血糖和严重高血糖分别定义为单次血糖水平大于15 mmol/L（270 mg/dL）和大于20 mmol/L（360 mg/dL）。低血糖和严重低血糖分别定义为任何单次血糖水平低于3.3 mmol/L（60 mg/dL）和低于2.2 mmol/L（40 mg/dL）。共记录了15912个血糖值。每位患者血糖值的中位数为59个，相当于平均每小时0.53±0.12次检测。69例（33.0%）无血糖异常且未接受胰岛素治疗的患者被定义为对照组。分别有89例（42.6%）和26例（12.4%）患者发生高血糖和严重高血糖。分别有63例（30.1%）和17例（8.1%）患者发生低血糖和严重低血糖。61例（29.2%）患者在体外膜肺氧合治疗期间接受了静脉胰岛素治疗。高血糖和低血糖均与体外膜肺氧合治疗期间死亡率增加相关（分别为46%和48%，而对照组为29%；p = 0.03）。然而，在调整疾病严重程度和体外膜肺氧合治疗并发症后，血糖异常水平与死亡率无独立相关性。
接受体外膜肺氧合治疗的儿童血糖紊乱很常见，但与死亡率增加无独立相关性。该高危人群的最佳血糖范围需要进一步研究。
