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Blood glucose control in critically ill adults and children: A survey on stated practice

¹University of Utah, Salt Lake City ²Université de Montréal ³University of Virginia, Charlottesville

elhirsh{at}yahoo.com

Abstract

Objectives: We document clinicians' stated blood glucose control practice patterns in North American pediatric and adult intensive care units (ICUs).

Methods: Using a web-based self-administered questionnaire we conducted a nationwide survey of North-American pediatric and adult ICUs. Participants included ICU medical directors, nurses, fellows in training and attending intensivists from participating ICUs in three critical care research networks.

Measurements and Main Results. Item generation and item selection were done according to standard scientific survey methods. Questions were designed to describe clinicians' perceptions about glucose control practices. The questionnaire topics included: respondent characteristics, ICU description, hyperglycemia, hypoglycemia, and glucose measurement. Institution response was 96% (50/52). Clinician response rate was 58% (163/282). Adult ICU clinicians defined hyperglycemia (120 mg/dl, 6.2 mmol/L) at a lower threshold than pediatric ICU clinicians (150 mg/dl, 8.3 mmol/L). Hypoglycemia was defined similarly by both groups (median < 60 mg/dl, 3.3 mmol/L; range: 40 to 80 mg/dl, 2.2 – 4.4 mmol/L). More pediatric ICU clinicians (84.5%) than adult ICU clinicians (59.1%) considered hypoglycemia more dangerous than hyperglycemia. A larger percentage of adult ICU clinicians (82.5%) than pediatric ICU clinicians (49.3%) preferred a target blood glucose level between 80 and 110 mg/dl (4.4 - 6.1 mmol/L). Clinical algorithms for glucose management varied among clinicians and across institutions.

Conclusions: Blood glucose control with insulin is used frequently for critically ill adults and children. A wide variation in practice exists in blood glucose targets, hyperglycemia and hypoglycemia definitions, and decision algorithms among North-American adult and pediatric ICUs.

Key Words: adults • child • blood glucose • critical care • goal-directed therapy • hypoglycemia • insulin • intensive care unit • pediatric • practice pattern • survey