Intensive insulin therapy for patients in paediatric intensive care: a prospective, randomised controlled study

Vlasselaers, Dirk; Milants, Ilse; Desmet, Lars; Wouters, Pieter; Vanhorebeek, Ilse; Heuvel, Ingeborg van den; Mesotten, Dieter; Casaer, Michaël P; Meyfroidt, Geert; Ingels, Catherine; Müller, Johannes; Cromphaut, Sophie Van; Schetz, Miet; Berghe, Greet Van den

doi:10.1016/s0140-6736(09)60044-1

Cited by 511 publications

(499 citation statements)

References 30 publications

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“…An RCT of strict glycemic control compared to moderate control using insulin in a pediatric ICU population found a reduction in mortality with an increase in hypoglycemia. Insulin therapy should only be conducted with frequent glucose monitoring in view of the risks for hypoglycemia which can be greater in newborns and children due to a) relative lack of glycogen stores and muscle mass for gluconeogenesis, and b) the heterogeneity of the population with some excreting no endogenous insulin and others demonstrating high insulin levels and insulin resistance [622][623][624][625][626][627][628].…”

Section: Mechanical Ventilationmentioning

confidence: 99%

Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock, 2012

Dellinger¹,

et al. 2013

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Section: Mechanical Ventilationmentioning

confidence: 99%

Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock, 2012

Dellinger¹,

et al. 2013

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“…Although not limited to sepsis cases, several successively announced large‐scale RCTs484, 485, 486, 487 have assessed the significance of implementing strict glycemic management in critically‐ill children. Thus, investigating the importance of this type of intervention in patients with severe sepsis is considered to be an important task.…”

Section: Cq19: Pediatric Considerationsmentioning

confidence: 99%

“…While four RCTs484, 485, 486, 487 targeting critically‐ill pediatric patients were adopted for a meta‐analysis of strict glycemic management (Srinivasan and Agus488), all four studies involved intensive care unit (ICU) patients other than sepsis patients, and no subgroup analysis limited to sepsis patients was reported.…”

Section: Cq19: Pediatric Considerationsmentioning

confidence: 99%

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

Nishida

Ogura

Egi

et al. 2018

Acute Medicine & Surgery

157

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Background and PurposeThe Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG 2016), a Japanese‐specific set of clinical practice guidelines for sepsis and septic shock created jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in February 2017 in Japanese. An English‐language version of these guidelines was created based on the contents of the original Japanese‐language version.MethodsMembers of the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine were selected and organized into 19 committee members and 52 working group members. The guidelines were prepared in accordance with the Medical Information Network Distribution Service (Minds) creation procedures. The Academic Guidelines Promotion Team was organized to oversee and provide academic support to the respective activities allocated to each Guideline Creation Team. To improve quality assurance and workflow transparency, a mutual peer review system was established, and discussions within each team were open to the public. Public comments were collected once after the initial formulation of a clinical question (CQ), and twice during the review of the final draft. Recommendations were determined to have been adopted after obtaining support from a two‐thirds (>66.6%) majority vote of each of the 19 committee members.ResultsA total of 87 CQs were selected among 19 clinical areas, including pediatric topics and several other important areas not covered in the first edition of the Japanese guidelines (J‐SSCG 2012). The approval rate obtained through committee voting, in addition to ratings of the strengths of the recommendation and its supporting evidence were also added to each recommendation statement. We conducted meta‐analyses for 29 CQs. Thirty seven CQs contained recommendations in the form of an expert consensus due to insufficient evidence. No recommendations were provided for 5 CQs.ConclusionsBased on the evidence gathered, we were able to formulate Japanese‐specific clinical practice guidelines that are tailored to the Japanese context in a highly transparent manner. These guidelines can easily be used not only by specialists, but also by non‐specialists, general clinicians, nurses, pharmacists, clinical engineers, and other healthcare professionals.

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“…A small number of prospective trials have used insulin infusions to treat hyperglycaemia and/or promote growth [16,[24][25][26][27][28][29][30][31][32]. All reported insulin infusion trials have used either protocols that fixed insulin dosing to weight or other factors [25], or clinician judgment to determine insulin infusion rates.…”

Section: Introductionmentioning

confidence: 99%

“…The upper limit for clinically desirable blood glucose concentration is also subject to debate [11]. Thus, glucose management goals vary widely between insulin therapy studies [30,35] and it is likely the desired target range for glucose may change in the future.…”

Section: Introductionmentioning

confidence: 99%

Development of blood glucose control for extremely premature infants

Compte

Chase

Lynn

et al. 2011

Computer Methods and Programs in Biomedicine

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Abstract:Extremely premature neonates often experience hyperglycaemia, which has been linked to increased mortality and worsened outcomes. Insulin therapy can assist in controlling blood glucose levels and promoting needed growth. This study presents the development of a model-based stochastic targeted controller designed to adapt insulin infusion rates to match the unique and changing metabolic state and control parameters of the neonate. Long-term usage of targeted BG control requires successfully forecasting variations in neonatal metabolic state, accounting for differences in clinical practices between units, and demonstrating robustness to errors that can occur in everyday clinical usage. Simulation studies were used to evaluate controller ability to target several common BG ranges and evaluate controller sensitivity to missed BG measurements and delays in control interventions on a virtual patient cohort of 25 infants developed from retrospective data. Initial clinical pilot trials indicated model performance matched expected performance from simulations. Stochastic targeted glucose control developed using validated patient-specific virtual trials can yield effective protocols for this cohort. Long-term trials show fundamental success, however clinical interface design appears as a critical factor to ensuring good compliance and thus good control.3

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Intensive insulin therapy for patients in paediatric intensive care: a prospective, randomised controlled study

Cited by 511 publications

References 30 publications

Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock, 2012

Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock, 2012

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

Development of blood glucose control for extremely premature infants

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