05). Almost all centers (29/30, 97%) believe that at least some subsets of adults with hyperglycemia should be routinely treated, while 20/30 (67%) stated that at least some subsets of children with hyperglycemia should routinely receive glycemic control (Table (Table2).2). There was a non-uniform response when sites were questioned check details whether hyperglycemia contributed to poor outcome in select subsets of pediatric patients. While most believe that hyperglycemia adversely affects outcomes in cardiac (70%), trauma (73%), and traumatic brain injury (80%) patients, significantly fewer thought that there was an effect on outcomes in general medical (27%) and surgical (40%) patients (P < 0.05).Table 2Pediatric ICU beliefs regarding glycemic controlTo determine if there was a difference in attitude or practice habits based on ICU size, we analyzed responses based on ICU capacity.
Significantly more (83%, 5/6) small ICUs (<12 beds) stated that subsets of critically ill children with hyperglycemia should be treated compared to large ICUs (>30 beds), in which only 55% (6/11) believed so (P < 0.05).In contrast to other reports, our survey assessed actual glycemic control practice habits in pediatric ICUs in the United States. Despite most centers reporting that they believe hyperglycemia worsens outcomes in many of their patients, and that at least some subsets of pediatric patients may benefit from glycemic control, only two (7%) centers reported that their facility uses a standard approach to screen for and treat hyperglycemia.
In addition, four other centers (13%) reported that they do have a standard approach to manage hyperglycemia despite no regular approach for screening (Table (Table3).3). The vast majority of centers surveyed (80%) do not have a regular or agreed upon approach to glycemic control. Small centers (<12 beds) were more likely to have a standard protocol for hyperglycemic treatment compared to moderate (12 to 30 beds) and large (>30 beds) ICUs, 33%, 15%, and 18%, respectively. For centers that do employ a standard treatment approach, all (6/6) indicated they may use insulin infusions for glycemic control, while some also attempt to manage hyperglycemia using intermittent insulin (subcutaneous or intravenous) and/or modification of dextrose in fluids. Three of six centers that use a standard approach to treatment AV-951 employ a written insulin infusion protocol.Table 3Pediatric ICU approach to hyperglycemia screening and managementWhile few centers reported the use of any standard protocol for hyperglycemia management, we also assessed the use of glycemic control based on physician discretion at each center.