Further, smaller ICUs believe glycemic control should be instituted at a lower BG threshold compared to larger ICUs, http://www.selleckchem.com/products/FTY720.html and were more likely to report a lower BG definition for hypoglycemia. Previous studies have not reviewed or mentioned similar discrepancies, but these differences may likely be due to the less challenging nature of devising and agreeing upon practice policies in smaller groups compared to those with many practitioners.Similar to findings by others, we report that most pediatric ICU practitioners (60%) believe that hypoglycemia is more dangerous than hyperglycemia in critically ill children [24,25]. Although there are reports of immediate and long-term sequela from hypoglycemic episodes in children, the direct relationship of the severity and duration of hypoglycemia to adverse effects is unclear.

The relatively recent influx of data showing high incidence, severity and correlation, and perhaps causal relationship of hyperglycemia with adverse effects in critical illness may begin to challenge practitioners’ concepts of whether hypo or hyperglycemia is more detrimental. We found that 70% of centers reported that fear of iatrogenic hypoglycemia is a major, if not the primary, barrier to instituting routine glycemic control in their pediatric ICU. Indeed, studies in adult ICUs regarding glycemic control report hypoglycemic (BG <2.2 mmol/L, 40 mg/dL) rates as high as 40% in patients receiving tight control with insulin [3,26,27]. In addition, 25% of patients participating in the recent pediatric randomized controlled trial conducted in Belgium suffered from BG <2.

2 mmol/L (40 mg/dL) [23]. These high profile reports likely will further contribute to fear and refractoriness of glycemic control in pediatric critical care. Yet there are numerous reports of adult centers that have implemented glycemic control measures without high incidence of hypoglycemia. Our own studies indicate that glycemic control can be implemented in pediatric medical/surgical and cardiac ICUs with little to no increase in hypoglycemic episodes [11,13]. Therefore elevated rates of iatrogenic hypoglycemia do not always necessarily follow the implementation of glycemic control protocols. Groups considering implementing glycemic control should realize that physician and staff education, training, and dedication may allow for the effective adoption of safe approaches to glycemic control.

Limitations Batimastat of our study should be noted. While we attempted to target centers of varying size, geographic location, acuity, practice model, and type, data obtained from this survey only represents a portion of pediatric critical care centers nationally. However, as there are approximately 340 pediatric critical care centers in the United States, our survey of 30 centers does represent approximately 9 to 10% of all centers, and thus we believe does include a respectable sample size of pediatric institutions [28].