Should paediatric critically ill patients receive insulin therapy to maintain strict normoglycaemia?

Joseph, a 4 year old boy with septic shock, lactic acidosis and multi-organ failure has been admitted to the paediatric intensive care unit. Mechanical ventilation, vaso-active support, and renal replacement therapy (CVVHD) are initiated. His serum glucose level is 10.5 mmol/l. The senior consultant decides to order insulin therapy in order to maintain strict normoglycaemia, but the junior fellow argues that there is no evidence that strict normoglycaemia improves outcome in critically ill children.

… but there is evidence from adults that this is the case. Should we always wait for information to be replicated in children- with the lower incidence of problems, increased difficulty with study organisation and relatively low financial input – before we act? Or should we just follow physiology and adult data?

Report by

D. G. Markhorst (dg.markhorst@vumc.nl), M. van Heerde, M. C. J. Kneyber
Paediatric intensivists
Paediatric intensive care unit, Vrije Universiteit medical center, Amsterdam The Netherlands