Short-Term Adverse Outcomes Associated With Hypoglycemia in Critically Ill Children

Heart And Lung Failure-Pediatric INsulin Titration (HALF-PINT) Study Investigators

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: Previous studies report worse short-term outcomes with hypoglycemia in critically ill children. These studies relied on intermittent blood glucose measurements, which may have introduced detection bias. We analyzed data from the Heart And Lung Failure-Pediatric INsulin Titration trial to determine the association of hypoglycemia with adverse short-term outcomes in critically ill children. DESIGN: Nested case-control study. SETTING: Thirty-five PICUs. A computerized algorithm that guided the timing of blood glucose measurements and titration of insulin infusion, continuous glucose monitors, and standardized glucose infusion rates were used to minimize hypoglycemia. PATIENTS: Nondiabetic children with cardiovascular and/or respiratory failure and hyperglycemia. Cases were children with any hypoglycemia (blood glucose < 60 mg/dL), whereas controls were children without hypoglycemia. Each case was matched with up to four unique controls according to age group, study day, and severity of illness.None. MEASUREMENTS AND MAIN RESULTS: A total of 112 (16.0%) of 698 children who received the Heart And Lung Failure-Pediatric INsulin Titration protocol developed hypoglycemia, including 25 (3.6%) who developed severe hypoglycemia (blood glucose < 40 mg/dL). Of these, 110 cases were matched to 427 controls. Hypoglycemia was associated with fewer ICU-free days (median, 15.3 vs 20.2 d; p = 0.04) and fewer hospital-free days (0 vs 7 d; p = 0.01) through day 28. Ventilator-free days through day 28 and mortality at 28 and 90 days did not differ between groups. More children with insulin-induced versus noninsulin-induced hypoglycemia had zero ICU-free days (35.8% vs 20.9%; p = 0.008). Outcomes did not differ between children with severe versus nonsevere hypoglycemia or those with recurrent versus isolated hypoglycemia. CONCLUSIONS: When a computerized algorithm, continuous glucose monitors and standardized glucose infusion rates were used to manage hyperglycemia in critically ill children with cardiovascular and/or respiratory failure, severe hypoglycemia (blood glucose < 40 mg/dL) was uncommon, but any hypoglycemia (blood glucose < 60 mg/dL) remained common and was associated with worse short-term outcomes.

Original languageEnglish (US)
Pages (from-to)706-714
Number of pages9
JournalCritical care medicine
Volume47
Issue number5
DOIs
StatePublished - May 1 2019

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Hypoglycemia
Critical Illness
Blood Glucose
Insulin
Glucose
Respiratory Insufficiency
Hyperglycemia
Pediatrics
Lung
Sick Leave
Mechanical Ventilators
Case-Control Studies
Age Groups

All Science Journal Classification (ASJC) codes

  • Critical Care and Intensive Care Medicine

Cite this

Heart And Lung Failure-Pediatric INsulin Titration (HALF-PINT) Study Investigators (2019). Short-Term Adverse Outcomes Associated With Hypoglycemia in Critically Ill Children. Critical care medicine, 47(5), 706-714. https://doi.org/10.1097/CCM.0000000000003699
Heart And Lung Failure-Pediatric INsulin Titration (HALF-PINT) Study Investigators. / Short-Term Adverse Outcomes Associated With Hypoglycemia in Critically Ill Children. In: Critical care medicine. 2019 ; Vol. 47, No. 5. pp. 706-714.
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abstract = "OBJECTIVES: Previous studies report worse short-term outcomes with hypoglycemia in critically ill children. These studies relied on intermittent blood glucose measurements, which may have introduced detection bias. We analyzed data from the Heart And Lung Failure-Pediatric INsulin Titration trial to determine the association of hypoglycemia with adverse short-term outcomes in critically ill children. DESIGN: Nested case-control study. SETTING: Thirty-five PICUs. A computerized algorithm that guided the timing of blood glucose measurements and titration of insulin infusion, continuous glucose monitors, and standardized glucose infusion rates were used to minimize hypoglycemia. PATIENTS: Nondiabetic children with cardiovascular and/or respiratory failure and hyperglycemia. Cases were children with any hypoglycemia (blood glucose < 60 mg/dL), whereas controls were children without hypoglycemia. Each case was matched with up to four unique controls according to age group, study day, and severity of illness.None. MEASUREMENTS AND MAIN RESULTS: A total of 112 (16.0{\%}) of 698 children who received the Heart And Lung Failure-Pediatric INsulin Titration protocol developed hypoglycemia, including 25 (3.6{\%}) who developed severe hypoglycemia (blood glucose < 40 mg/dL). Of these, 110 cases were matched to 427 controls. Hypoglycemia was associated with fewer ICU-free days (median, 15.3 vs 20.2 d; p = 0.04) and fewer hospital-free days (0 vs 7 d; p = 0.01) through day 28. Ventilator-free days through day 28 and mortality at 28 and 90 days did not differ between groups. More children with insulin-induced versus noninsulin-induced hypoglycemia had zero ICU-free days (35.8{\%} vs 20.9{\%}; p = 0.008). Outcomes did not differ between children with severe versus nonsevere hypoglycemia or those with recurrent versus isolated hypoglycemia. CONCLUSIONS: When a computerized algorithm, continuous glucose monitors and standardized glucose infusion rates were used to manage hyperglycemia in critically ill children with cardiovascular and/or respiratory failure, severe hypoglycemia (blood glucose < 40 mg/dL) was uncommon, but any hypoglycemia (blood glucose < 60 mg/dL) remained common and was associated with worse short-term outcomes.",
author = "{Heart And Lung Failure-Pediatric INsulin Titration (HALF-PINT) Study Investigators} and Faustino, {Edward Vincent S.} and Hirshberg, {Eliotte L.} and Asaro, {Lisa A.} and Biagas, {Katherine V.} and Neethi Pinto and Vijay Srinivasan and Bagdure, {Dayanand N.} and Steil, {Garry M.} and Kerry Coughlin-Wells and David Wypij and Nadkarni, {Vinay M.} and Agus, {Michael S.D.} and Mourani, {Peter M.} and Ranjit Chima and Thomas, {Neal J.} and Simon Li and Alan Pinto and Christopher Newth and Neal Thomas and Kris Bysani and Rehder, {Kyle J.} and Sarah Kandil and Kupper Wintergerst and Adam Schwarz and Lauren Marsillio and Natalie Cvijanovich and Nga Pham and Michael Quasney and Heidi Flori and Myke Federman and Sholeen Nett and Shirley Viteri and James Schneider and Shivanand Medar and Anil Sapru and Patrick McQuillen and Christopher Babbitt and Lin, {John C.} and Philippe Jouvet and Ofer Yanay and Christine Allen",
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Heart And Lung Failure-Pediatric INsulin Titration (HALF-PINT) Study Investigators 2019, 'Short-Term Adverse Outcomes Associated With Hypoglycemia in Critically Ill Children', Critical care medicine, vol. 47, no. 5, pp. 706-714. https://doi.org/10.1097/CCM.0000000000003699

Short-Term Adverse Outcomes Associated With Hypoglycemia in Critically Ill Children. / Heart And Lung Failure-Pediatric INsulin Titration (HALF-PINT) Study Investigators.

In: Critical care medicine, Vol. 47, No. 5, 01.05.2019, p. 706-714.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Short-Term Adverse Outcomes Associated With Hypoglycemia in Critically Ill Children

AU - Heart And Lung Failure-Pediatric INsulin Titration (HALF-PINT) Study Investigators

AU - Faustino, Edward Vincent S.

AU - Hirshberg, Eliotte L.

AU - Asaro, Lisa A.

AU - Biagas, Katherine V.

AU - Pinto, Neethi

AU - Srinivasan, Vijay

AU - Bagdure, Dayanand N.

AU - Steil, Garry M.

AU - Coughlin-Wells, Kerry

AU - Wypij, David

AU - Nadkarni, Vinay M.

AU - Agus, Michael S.D.

AU - Mourani, Peter M.

AU - Chima, Ranjit

AU - Thomas, Neal J.

AU - Li, Simon

AU - Pinto, Alan

AU - Newth, Christopher

AU - Thomas, Neal

AU - Bysani, Kris

AU - Rehder, Kyle J.

AU - Kandil, Sarah

AU - Wintergerst, Kupper

AU - Schwarz, Adam

AU - Marsillio, Lauren

AU - Cvijanovich, Natalie

AU - Pham, Nga

AU - Quasney, Michael

AU - Flori, Heidi

AU - Federman, Myke

AU - Nett, Sholeen

AU - Viteri, Shirley

AU - Schneider, James

AU - Medar, Shivanand

AU - Sapru, Anil

AU - McQuillen, Patrick

AU - Babbitt, Christopher

AU - Lin, John C.

AU - Jouvet, Philippe

AU - Yanay, Ofer

AU - Allen, Christine

PY - 2019/5/1

Y1 - 2019/5/1

N2 - OBJECTIVES: Previous studies report worse short-term outcomes with hypoglycemia in critically ill children. These studies relied on intermittent blood glucose measurements, which may have introduced detection bias. We analyzed data from the Heart And Lung Failure-Pediatric INsulin Titration trial to determine the association of hypoglycemia with adverse short-term outcomes in critically ill children. DESIGN: Nested case-control study. SETTING: Thirty-five PICUs. A computerized algorithm that guided the timing of blood glucose measurements and titration of insulin infusion, continuous glucose monitors, and standardized glucose infusion rates were used to minimize hypoglycemia. PATIENTS: Nondiabetic children with cardiovascular and/or respiratory failure and hyperglycemia. Cases were children with any hypoglycemia (blood glucose < 60 mg/dL), whereas controls were children without hypoglycemia. Each case was matched with up to four unique controls according to age group, study day, and severity of illness.None. MEASUREMENTS AND MAIN RESULTS: A total of 112 (16.0%) of 698 children who received the Heart And Lung Failure-Pediatric INsulin Titration protocol developed hypoglycemia, including 25 (3.6%) who developed severe hypoglycemia (blood glucose < 40 mg/dL). Of these, 110 cases were matched to 427 controls. Hypoglycemia was associated with fewer ICU-free days (median, 15.3 vs 20.2 d; p = 0.04) and fewer hospital-free days (0 vs 7 d; p = 0.01) through day 28. Ventilator-free days through day 28 and mortality at 28 and 90 days did not differ between groups. More children with insulin-induced versus noninsulin-induced hypoglycemia had zero ICU-free days (35.8% vs 20.9%; p = 0.008). Outcomes did not differ between children with severe versus nonsevere hypoglycemia or those with recurrent versus isolated hypoglycemia. CONCLUSIONS: When a computerized algorithm, continuous glucose monitors and standardized glucose infusion rates were used to manage hyperglycemia in critically ill children with cardiovascular and/or respiratory failure, severe hypoglycemia (blood glucose < 40 mg/dL) was uncommon, but any hypoglycemia (blood glucose < 60 mg/dL) remained common and was associated with worse short-term outcomes.

AB - OBJECTIVES: Previous studies report worse short-term outcomes with hypoglycemia in critically ill children. These studies relied on intermittent blood glucose measurements, which may have introduced detection bias. We analyzed data from the Heart And Lung Failure-Pediatric INsulin Titration trial to determine the association of hypoglycemia with adverse short-term outcomes in critically ill children. DESIGN: Nested case-control study. SETTING: Thirty-five PICUs. A computerized algorithm that guided the timing of blood glucose measurements and titration of insulin infusion, continuous glucose monitors, and standardized glucose infusion rates were used to minimize hypoglycemia. PATIENTS: Nondiabetic children with cardiovascular and/or respiratory failure and hyperglycemia. Cases were children with any hypoglycemia (blood glucose < 60 mg/dL), whereas controls were children without hypoglycemia. Each case was matched with up to four unique controls according to age group, study day, and severity of illness.None. MEASUREMENTS AND MAIN RESULTS: A total of 112 (16.0%) of 698 children who received the Heart And Lung Failure-Pediatric INsulin Titration protocol developed hypoglycemia, including 25 (3.6%) who developed severe hypoglycemia (blood glucose < 40 mg/dL). Of these, 110 cases were matched to 427 controls. Hypoglycemia was associated with fewer ICU-free days (median, 15.3 vs 20.2 d; p = 0.04) and fewer hospital-free days (0 vs 7 d; p = 0.01) through day 28. Ventilator-free days through day 28 and mortality at 28 and 90 days did not differ between groups. More children with insulin-induced versus noninsulin-induced hypoglycemia had zero ICU-free days (35.8% vs 20.9%; p = 0.008). Outcomes did not differ between children with severe versus nonsevere hypoglycemia or those with recurrent versus isolated hypoglycemia. CONCLUSIONS: When a computerized algorithm, continuous glucose monitors and standardized glucose infusion rates were used to manage hyperglycemia in critically ill children with cardiovascular and/or respiratory failure, severe hypoglycemia (blood glucose < 40 mg/dL) was uncommon, but any hypoglycemia (blood glucose < 60 mg/dL) remained common and was associated with worse short-term outcomes.

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DO - 10.1097/CCM.0000000000003699

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Heart And Lung Failure-Pediatric INsulin Titration (HALF-PINT) Study Investigators. Short-Term Adverse Outcomes Associated With Hypoglycemia in Critically Ill Children. Critical care medicine. 2019 May 1;47(5):706-714. https://doi.org/10.1097/CCM.0000000000003699