Although some studies have portrayed tight blood sugar control as a potential means of lowering infection rates in critically ill adults, a new study found no indication that the approach benefits pediatric patients undergoing heart surgery.
Researchers with Boston Children’s Hospital and the University of Michigan C.S. Mott Children’s Hospital examined the effects of tight glycemic control with insulin compared with standard glucose management in 980 children hospitalized in the CICU. All patients, ranging from newborn to age 3, underwent open heart surgery with heart-lung bypass.
"The cardiac problems faced by the children in our patient population are fundamentally different than the cardiac problems affecting adults," Michael Agus, MD, the study’s principal investigator and director of the Medicine Critical Care Program at Boston Children’s, said in a news release. "But we chose to focus on CICU patients because the cardiac arena is where the bulk of the benefits have been observed in adults."
The researchers discovered that using insulin to maintain normal blood sugar levels had no demonstrable impact on the incidence of care-related infections, length of stay in the CICU, organ failure or mortality.
Among the positive outcomes of the trial, Agus said, was establishing that children and adults are different regarding the benefit of glucose control in a CICU, and that clinicians can safely control glucose in a young, vulnerable, sick population.
The research team used subcutaneous glucose monitors and a custom insulin-dosing algorithm that took continuous values into account, only making changes based on a specific blood value. Consequently, Agus said, "we put together a system that achieved normal glucose control with the lowest hypoglycemia rate ever documented in a prospective trial."
Effect on nurses
The investigators also identified a risk category posed by adding unproven new therapies to the patient care regimen: increasing the workload for nursing staff. Bedside nurses performed a median of 14.2 blood glucose measurements during a 24-hour period in children in the glycemic-control group, compared with 3.6 measurements in children in the standard-care group, the researchers wrote.
Agus said the nurses in the study "shouldered a significant workload while keeping their focus on the central aspects of patient care. Every task that a nurse does at the bedside ought to be examined scientifically, and that is a significant insight gleaned by this study."
The study is scheduled for publication in the Sept. 27 issue of the New England Journal of Medicine. To read the study, visit www.nejm.org/doi/full/10.1056/NEJMoa1206044?query=featured_home#t=article.
Researchers with Boston Children’s Hospital and the University of Michigan C.S. Mott Children’s Hospital examined the effects of tight glycemic control with insulin compared with standard glucose management in 980 children hospitalized in the CICU. All patients, ranging from newborn to age 3, underwent open heart surgery with heart-lung bypass.
"The cardiac problems faced by the children in our patient population are fundamentally different than the cardiac problems affecting adults," Michael Agus, MD, the study’s principal investigator and director of the Medicine Critical Care Program at Boston Children’s, said in a news release. "But we chose to focus on CICU patients because the cardiac arena is where the bulk of the benefits have been observed in adults."
The researchers discovered that using insulin to maintain normal blood sugar levels had no demonstrable impact on the incidence of care-related infections, length of stay in the CICU, organ failure or mortality.
Among the positive outcomes of the trial, Agus said, was establishing that children and adults are different regarding the benefit of glucose control in a CICU, and that clinicians can safely control glucose in a young, vulnerable, sick population.
The research team used subcutaneous glucose monitors and a custom insulin-dosing algorithm that took continuous values into account, only making changes based on a specific blood value. Consequently, Agus said, "we put together a system that achieved normal glucose control with the lowest hypoglycemia rate ever documented in a prospective trial."
Effect on nurses
The investigators also identified a risk category posed by adding unproven new therapies to the patient care regimen: increasing the workload for nursing staff. Bedside nurses performed a median of 14.2 blood glucose measurements during a 24-hour period in children in the glycemic-control group, compared with 3.6 measurements in children in the standard-care group, the researchers wrote.
Agus said the nurses in the study "shouldered a significant workload while keeping their focus on the central aspects of patient care. Every task that a nurse does at the bedside ought to be examined scientifically, and that is a significant insight gleaned by this study."
The study is scheduled for publication in the Sept. 27 issue of the New England Journal of Medicine. To read the study, visit www.nejm.org/doi/full/10.1056/NEJMoa1206044?query=featured_home#t=article.
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