Impact of Tight Glycemic Control in Severely Burned Children

Abstract

Control of hyperglycemia has been shown to decrease mortality in critically ill adults, but the benefits of strict glucose control have not been established in children. Since January 2002, our pediatric burn center has adopted a policy of 'intensive' insulin therapy to achieve blood glucose levels 90 to 120 mg/dL. The purpose of this study was to examine the impact of this practice on patient outcomes. We reviewed the records of children with > or =30% total body surface area (TBSA) burn injury admitted to our regional pediatric burn center from July 1, 2000 to June 31, 2003. Patients were grouped into 'conventional insulin therapy' for the 2000 to 2001 period (n = 31) and into 'intensive insulin therapy' for the 2002 to 2003 period (n = 33). The efficacy of glucose control, infection rates, and patient survival were compared for the two therapies. The demographic characteristics and injury severity were similar between the conventional and intensive insulin therapy groups. Children receiving intensive insulin therapy had glucose levels of 90 to 120 mg/dL more consistently than those in the conventional insulin therapy group. There was a significant decrease in urinary tract infections among intensive insulin therapy patients. TBSA burn, percent full-thickness burn, and Pediatric Risk of Mortality scores were negatively related to survival; intensive insulin therapy was positively associated with survival. Intensive insulin therapy to maintain normoglycemia in severely burned children can be safely and effectively implemented in the burn unit. This therapy seems to lower infection rates and improve survival. Intensive insulin therapy should be considered for children with severe burn injuries.