Abstract
IntroductionHyperglycemia in children after cardiac surgery can be treated with intensive insulin therapy, but hypoglycemia is a potential serious side effect. The aim of this study was to investigate the effects of reducing glucose intake below standard intakes to prevent hyperglycemia, on blood glucose concentrations, glucose kinetics and protein catabolism in children after cardiac surgery with cardiopulmonary bypass (CPB).MethodsSubjects received a 4-hour low glucose (LG; 2.5 mg/kg per minute) and a 4-hour standard glucose (SG; 5.0 mg/kg per minute) infusion in a randomized blinded crossover setting. Simultaneously, an 8-hour stable isotope tracer protocol was conducted to determine glucose and leucine kinetics. Data are presented as mean ± SD or median (IQR); comparison was made by paired samples t test.ResultsEleven subjects (age 5.1 (20.2) months) were studied 9.5 ± 1.9 hours post-cardiac surgery. Blood glucose concentrations were lower during LG than SG (LG 7.3 ± 0.7 vs. SG 9.3 ± 1.8 mmol/L; P < 0.01), although the glycemic target (4.0-6.0 mmol/L) was not achieved. No hypoglycemic events occurred. Endogenous glucose production was higher during LG than SG (LG 2.9 ± 0.8 vs. SG 1.5 ± 1.1 mg/kg per minute; P = 0.02), due to increased glycogenolysis (LG 1.0 ± 0.6 vs. SG 0.0 ± 1.0 mg/kg per minute; P < 0.05). Leucine balance, indicating protein balance, was negative but not affected by glucose intake (LG -54.8 ± 14.6 vs. SG -58.8 ± 16.7 μmol/kg per hour; P = 0.57).ConclusionsCurrently recommended glucose intakes aggravated hyperglycemia in children early after cardiac surgery with CPB. Reduced glucose intake decreased blood glucose concentrations without causing hypoglycemia or affecting protein catabolism, but increased glycogenolysis.Trial registrationDutch trial register NTR2079.
Highlights
Hyperglycemia in children after cardiac surgery can be treated with intensive insulin therapy, but hypoglycemia is a potential serious side effect
In 11 subjects, blood glucose concentrations were available during both glucose infusion periods
Our study showed that currently recommended glucose intakes aggravated hyperglycemia in children admitted to the pediatric intensive care unit (PICU) in the first 24 hours after cardiac surgery with cardiopulmonary bypass (CPB)
Summary
Hyperglycemia in children after cardiac surgery can be treated with intensive insulin therapy, but hypoglycemia is a potential serious side effect. Hyperglycemia in critically ill children is reported to be associated with increased morbidity and mortality [9,10,11]. This has led to the widespread use of insulin therapy to achieve blood glucose targets in the pediatric intensive care unit (PICU) [12]. A randomized trial in critically ill children, three quarters of whom were cardiac surgery patients, showed that at the research location intensive insulin therapy was associated with a decrease in mortality of 6% to 3% and a decreased morbidity [13]. Hypoglycemia has been associated with adverse outcome in the PICU [10] and may adversely affect the developing brain of young children [14,15,16]
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