Assessing the benefits and risks of tight glycemic control in critically ill children

Abstract

Sarah B Kandil, E Vincent Faustino Department of Pediatrics, Division of Pediatric Critical Care, Yale University School of Medicine, New Haven, CT, USA Abstract: The benefit of intravenous insulin for tight glycemic control (TGC) in critically ill patients is debatable. Initial single center trials on TGC in critically ill adults admitted to the surgical intensive care unit were promising and showed a decrease in mortality with TGC. However, subsequent multicenter trials were unable to replicate these findings, with one trial even showing increased mortality with TGC. In critically ill children, efficacy and safety of TGC is poorly understood. High rates of insulin-induced hypoglycemia with TGC are concerning. Currently, there are no recommendations on the use of TGC for critically ill children. This review summarizes the current literature on TGC in children, focusing on its benefits and risks. Keywords: hyperglycemia, hypoglycemia, intensive care unit, insulin, glucose