{"id":16,"date":"2007-10-09T11:23:02","date_gmt":"2007-10-09T10:23:02","guid":{"rendered":"https:\/\/blogs.bmj.com\/adc-archimedes\/2007\/10\/09\/unanswered-question-should-paediatric-critically-ill-patients-receive-insulin-therapy-to-maintain-strict-normoglycaemia\/"},"modified":"2007-10-09T11:23:02","modified_gmt":"2007-10-09T10:23:02","slug":"unanswered-question-should-paediatric-critically-ill-patients-receive-insulin-therapy-to-maintain-strict-normoglycaemia","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/adc\/2007\/10\/09\/unanswered-question-should-paediatric-critically-ill-patients-receive-insulin-therapy-to-maintain-strict-normoglycaemia\/","title":{"rendered":"Question: Insulin for hyperglycaemic PICU patients?"},"content":{"rendered":"<h3>Should paediatric critically ill patients receive insulin therapy to maintain strict normoglycaemia?<\/h3>\n<p><img decoding=\"async\" src=\"http:\/\/farm1.static.flickr.com\/29\/66383569_02923bf299.jpg?v=0\" alt=\"Blood sugar monitor\" align=\"left\" hspace=\"5\" width=\"120\" \/>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.<\/p>\n<p><!--more-->&#8230; but there is evidence from <a href=\"http:\/\/www.survivingsepsis.com\/bundles\/individual_changes\/maintain_glycemic\" title=\"Glycemic control in adults\">adults <\/a>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 &#8211; before we act? Or should we just follow physiology and adult data?<\/p>\n<p><strong>Report by<\/strong><\/p>\n<p>D. G. Markhorst (dg.markhorst@vumc.nl), M. van Heerde, M. C. J. Kneyber<br \/>\nPaediatric intensivists<br \/>\nPaediatric intensive care unit, Vrije Universiteit medical center, Amsterdam The Netherlands<!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>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 [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/adc\/2007\/10\/09\/unanswered-question-should-paediatric-critically-ill-patients-receive-insulin-therapy-to-maintain-strict-normoglycaemia\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":7,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[150,149,82],"tags":[],"class_list":["post-16","post","type-post","status-publish","format-standard","hentry","category-picu","category-sepsis","category-therapy"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Question: Insulin for hyperglycaemic PICU patients? - ADC Online Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/adc\/2007\/10\/09\/unanswered-question-should-paediatric-critically-ill-patients-receive-insulin-therapy-to-maintain-strict-normoglycaemia\/\" \/>\n<meta property=\"og:locale\" content=\"en_GB\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Question: Insulin for hyperglycaemic PICU patients? - ADC Online Blog\" \/>\n<meta property=\"og:description\" content=\"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 [...]Read More...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/adc\/2007\/10\/09\/unanswered-question-should-paediatric-critically-ill-patients-receive-insulin-therapy-to-maintain-strict-normoglycaemia\/\" \/>\n<meta property=\"og:site_name\" content=\"ADC Online Blog\" \/>\n<meta property=\"article:published_time\" content=\"2007-10-09T10:23:02+00:00\" \/>\n<meta property=\"og:image\" content=\"http:\/\/farm1.static.flickr.com\/29\/66383569_02923bf299.jpg?v=0\" \/>\n<meta name=\"author\" content=\"Bob Phillips\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Bob Phillips\" \/>\n\t<meta name=\"twitter:label2\" content=\"Estimated reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"1 minute\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/adc\\\/2007\\\/10\\\/09\\\/unanswered-question-should-paediatric-critically-ill-patients-receive-insulin-therapy-to-maintain-strict-normoglycaemia\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/adc\\\/2007\\\/10\\\/09\\\/unanswered-question-should-paediatric-critically-ill-patients-receive-insulin-therapy-to-maintain-strict-normoglycaemia\\\/\"},\"author\":{\"name\":\"Bob Phillips\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/adc\\\/#\\\/schema\\\/person\\\/9e94029681ecf36e73bbd1eb2be2ef94\"},\"headline\":\"Question: Insulin for hyperglycaemic PICU patients?\",\"datePublished\":\"2007-10-09T10:23:02+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/adc\\\/2007\\\/10\\\/09\\\/unanswered-question-should-paediatric-critically-ill-patients-receive-insulin-therapy-to-maintain-strict-normoglycaemia\\\/\"},\"wordCount\":171,\"commentCount\":1,\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/adc\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/adc\\\/2007\\\/10\\\/09\\\/unanswered-question-should-paediatric-critically-ill-patients-receive-insulin-therapy-to-maintain-strict-normoglycaemia\\\/#primaryimage\"},\"thumbnailUrl\":\"http:\\\/\\\/farm1.static.flickr.com\\\/29\\\/66383569_02923bf299.jpg?v=0\",\"articleSection\":[\"PICU\",\"sepsis\",\"therapy\"],\"inLanguage\":\"en-GB\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/adc\\\/2007\\\/10\\\/09\\\/unanswered-question-should-paediatric-critically-ill-patients-receive-insulin-therapy-to-maintain-strict-normoglycaemia\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/adc\\\/2007\\\/10\\\/09\\\/unanswered-question-should-paediatric-critically-ill-patients-receive-insulin-therapy-to-maintain-strict-normoglycaemia\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/adc\\\/2007\\\/10\\\/09\\\/unanswered-question-should-paediatric-critically-ill-patients-receive-insulin-therapy-to-maintain-strict-normoglycaemia\\\/\",\"name\":\"Question: Insulin for hyperglycaemic PICU patients? 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