A disparity between physician attitudes and practice regarding hyperglycemia in pediatric intensive care units in the United States: a survey on actual practice habits

Catherine M Preissig, Mark R Rigby, Catherine M Preissig, Mark R Rigby

Abstract

Introduction: Hyperglycemia is common in critically ill patients and is associated with increased morbidity and mortality. Strict glycemic control improves outcomes in some adult populations and may have similar effects in children. While glycemic control has become standard care in adults, little is known regarding hyperglycemia management strategies used by pediatric critical care practitioners. We sought to assess both the beliefs and practice habits regarding glycemic control in pediatric intensive care units (ICUs) in the United States (US).

Methods: We surveyed 30 US pediatric ICUs from January to May 2009. Surveys were conducted by phone between the investigators and participating centers and consisted of a 22-point questionnaire devised to assess physician perceptions and center-specific management strategies regarding glycemic control.

Results: ICUs included a cross section of centers throughout the US. Fourteen out of 30 centers believe all critically ill hyperglycemic adults should be treated, while 3/30 believe all critically ill children should be treated. Twenty-nine of 30 believe some subsets of adults with hyperglycemia should be treated, while 20/30 believe some subsets of children should receive glycemic control. A total of 70%, 73%, 80%, 27%, and 40% of centers believe hyperglycemia adversely affects outcomes in cardiac, trauma, traumatic brain injury, general medical, and general surgical pediatric patients, respectively. However, only six centers use a standard, uniform approach to treat hyperglycemia at their institution. Sixty percent of centers believe hypoglycemia is more dangerous than hyperglycemia. Seventy percent listed fear of management-induced hypoglycemia as a barrier to glycemic control at their center.

Conclusions: Considerable disparity exists between physician beliefs and actual practice habits regarding glycemic control among pediatric practitioners, with few centers reporting the use of any consistent standard approach to screening and management. Physicians wishing to practice glycemic control in their critically ill pediatric patients may want to consider adopting center-wide uniform approaches to improve safety and efficacy of treatment.

Figures

Figure 1
Figure 1
Pediatric intensivist actual glycemic control practice habits. Centers were queried regarding what percentage of practitioners always practice glycemic control, sometimes practice glycemic control, or never practice glycemic in all, most, some, few, and none of their hyperglycemic patients. Small ICU = <12 beds, Medium ICU = 12 to 30 beds, Large ICU = >30 beds. ICU = intensive care unit.
Figure 2
Figure 2
Level of blood glucose to define hyperglycemia in different ICUs. Centers were queried regarding their definition of hyperglycemia. Small ICU = <12 beds, Medium ICU = 12 to 30 beds, Large ICU = >30 beds. ICU = intensive care unit.

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Source: PubMed

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