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Blood Glucose Control in Critically Ill Adults and Children^*

A Survey on Stated Practice

^* From the University of Utah (Drs. Hirshberg, Sward, and Morris), Salt Lake City, UT; Université de Montréal (Dr. Lacroix), Montréal, QC, Canada; and the University of Virginia (Dr. Willson), Charlottesville, VA.

Correspondence to: Eliotte Hirshberg, MD, University of Utah, Internal Medicine and Pediatrics, 101 N Medical Dr, Salt Lake City, UT 84113; e-mail: ellie.hirshberg{at}hsc.utah.edu

Abstract

Objectives: We document clinicians’ stated blood glucose control practice patterns in North American pediatric and adult 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 performed according to standard scientific survey methods. Questions were designed to describe clinicians’ perceptions about glucose control practices. The questionnaire topics included the following: respondent characteristics; ICU description; hyperglycemia; hypoglycemia; and glucose measurement. The institutional response rate was 96% (50 of 52 institutions). The clinician response rate was 58% (163 of 282 physicians). 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 to 4.4 mmol/L]). More pediatric ICU clinicians (84.5%) than adult ICU clinicians (59.1%) considered hypoglycemia to be 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 to 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 • ICU • insulin • pediatric • practice pattern • survey