Pediatric Critical Illness Hyperglycemia and Glycemic Control Registry
Condition: Hypoglycemia Hyperglycemia
MeSH terms: Hypoglycemia; Hyperglycemia; Critical Illness
Study type: Observational

Summary: 
      The objective in this project is to assemble a consortium of pediatric critical care centers
      of varying size, acuity, and composition to evaluate our glycemic control protocol on at
      least 250 children with hyperglycemia in different critical care units.

      ***This Study is supported by an R21 Grant (MRR) from the National Institute of Diabetes and
      Digestive and Kidney Diseases (NIDDK).
    

Detailed description: 
      Many studies over the past decade have demonstrated that clinical outcomes can be improved in
      critically ill adults by aggressive management of hyperglycemic with insulin infusions (Van
      Den Berghe 2001, Van Den Berghe 2006, Krinsey 2004, Treggari 2008, Scalea, 2007, Lang 2007).
      Yet, in some of these studies and other recent trials (i.e. Glucontrol (Preiser, 2009) VISEP
      (Brunkhorst, 2008) and (NICE-SUGAR, 2009)), have highlighted the potential and real risks of
      glycemic control (namely iatrogenic hypoglycemia) and questioned how effectively glucose can
      be controlled in critical illness. One reason for the suboptimal glycemic control witnessed
      in some trials may be not rigorously refined and validated. Even as such, many medical
      oversight committees (including the Institutes of Healthcare Improvement, the American
      Diabetes Association, and Society of Critical Care Medicine, among others) continue to
      recommend regular and aggressive glycemic control in critically ill patients. Although not
      specifically included nor excluded from such recommendations, most pediatric intensivists
      have not incorporated glycemic control into regular practice primarily due to concerns of
      therapy induced hyperglycemia - although there are reports of protocols that appear to be
      effective at controlling BG levels with low rates of hypoglycemia (Preissig et al 2008,
      Verhoeven et al 2009).

      Our group at Emory University and Children's' Healthcare of Atlanta has taken a progressive,
      yet methodical, approach to better understand the implications of hyperglycemia and its
      treatment in critically ill and injured children. Practitioners at our facility developed a
      pediatric-specific protocol to identify and treat hyperglycemia in critically ill children.
      We have instituted this approach as standard care in our facility and have experience with
      managing several hundred children with hyperglycemia. Our approach to glycemic management has
      very promising safety and efficacy profiles, even when compared to the most stringent and
      successful glycemic control protocols used in adults. We published the first experience in
      pediatric glycemic control in pediatric in 2008 (Preissig et al PCCM 2008) and have used our
      experience to identify specific risk factors for developing hypoglycemia (Preissig et al
      JPed, 2009).

      The goal of this proposal is to assist our step-wise approach in investigating hyperglycemia
      in critically ill children by externally validating our glycemic control protocol via
      multi-center evaluation. In doing so, we will also be developing the infrastructure and a
      tested intervention that can be leveraged for future studies of hyperglycemia in pediatric
      critical illness, including a multi-center outcome trial. The specific hypothesis for this
      project is that our protocol is safe and efficient at identifying and managing hyperglycemia
      in critically ill or injured children in pediatric ICUs regardless of ICU size, acuity,
      model, staffing makeup, or clinical focus.
    

Observational model: Case-Only
Sampling method: Non-Probability Sample
Study population: 
        Childern upto 18 or 21 years old admitted to pedaitric intensive care units who are ar risk
        for deleveloping critical illness hyperglycemia.
      
Keywords: Intensive critical care, glycemic control, hypoglycemia, hyperglycemia , insulin treatment, intensive care outcomes, pediatrics