Hyperglycemia is a marker for poor outcome in the postoperative pediatric cardiac patient*

Abstract

Hyperglycemia in the postoperative period was associated with increased morbidity and mortality in postoperative pediatric cardiac patient. Strict glycemic control may improve outcomes in this patient population.

Prevalence and clinical outcome of inpatient hyperglycemia in a community pediatric hospital

“…They reported a 2.5-fold increased risk of dying if the maximum glucose obtained within 24 hours of admission to the ICU was >150 mg/dL. More recently, Yates et al 25 reported that hyperglycemia in the postoperative period was associated with increased morbidity and mortality in postoperative pediatric cardiac patients. Other studies in children with traumatic brain or head injury have also shown an association between poor neurological outcome and elevated admission blood glucose.…”

Stress Hyperglycemia in Pediatric Critical Illness: The Intensive Care Unit Adds to the Stress!

“…68,69 Cardiopulmonary bypass is thought to result in SH through a combination of inflammatory cytokine release, vasoactive infusion use, pancreatic β-cell dysfunction, hypothermia with insulin resistance, and steroid use. 68 While some studies have demonstrated the association of SH with poor outcomes in children undergoing cardiac surgery 14,29,30,69,70 , other studies have not shown any impact of SH on long-term neurodevelopmental outcomes following cardiac surgery involving CPB. [71][72][73] Similar to CPB, ECLS is also associated with development of SH in critically ill children.…”

“…1,29 This association of SH with mortality appears across different pediatric disease states, including septic shock, burns, traumatic brain injury, post cardiac surgery, and trauma. [10][11][12][13][14][15][16] Additionally, SH is associated with longer periods of ICU and hospital stay and more frequent nosocomial infections, including surgical site infections in critically ill children. [2][3][4][5][6]29,30 While all these studies demonstrate strong associations between SH and poor clinical outcomes, they do not necessarily demonstrate a cause and effect relationship, because SH tends to be more marked in patients with greater illness severity.…”

“…1,29 Several studies have demonstrated the association of SH in critically ill children with mortality. [1][2][3][4][5][10][11][12][13][14][15][16] Specifically, peak and duration of SH appear to be associated with mortality. Peak BG concentrations tend to be much higher in nonsurvivors compared with survivors.…”

“…8,9 However, studies in children have challenged this assertion by observing that SH during critical illness is associated with poor outcomes. [1][2][3][4][5][6][7][10][11][12][13][14][15][16] Based on the premise that SH during critical illness is possibly harmful, tight glucose control (TGC) to normalize blood glucose (BG) concentrations has emerged as a rational but unproven therapy to improve outcomes in critically ill children. Studies of TGC in critically ill adults have had mixed results, with some observing worse outcomes from TGC.…”