Improvements in resting energy expenditure in severely burned pediatric patients after 14 days of treatment with an intensive insulin therapy protocol in the acute care setting

Abstract

Introduction: Controlling blood glucose levels between 80 mg/dl and 110 mg/dl by means of insulin therapy in adult intensive care units has led to improvements in mortality and clinical outcomes. Tight glycemic control has not been assessed in the pediatric population to see if these patients will also benefit from treatment. It was our goal to implement an intensive insulin therapy protocol in severely burned children and to evaluate if the hypermetabolic response that occurs with severe trauma was mediated. Methods: A total of 20 children, 23 months to 15 years of age with total body surface area burn greater than 40% were assigned to one of two groups. In the intensive insulin treatment group, blood glucose was controlled between 80 mg/dl and 110 mg/dl using continuous insulin infusion. In the conventional insulin treatment group, blood glucose was maintained below 215 mg/dl by means of intermittent dosing of intravenous insulin. Indirect calorimetry was performed at the bedside 7 days post-burn, prior to insulin treatment, and 14 days after treatment (21 days post-burn) to assess changes in the hypermetabolic burn response. Results: Resting energy expenditure in patients receiving the intensive insulin therapy protocol decreased from 1678 ± 164.1 kcal/m2/day to 1515 ± 199.8 kcal/m2/day (p=0.254). Resting energy expenditure in patients receiving the conventional insulin therapy protocol increased from 1475.8 ± 123.8 kcal/m2/day to 1924.7 ± 290.6 kcal/m2/day (p=0.024). Overall, after treating patients with 14 days of intensive insulin therapy, resting energy expenditure decreased by 303 ± 183.4 kcal/m2/day as compared to the conventional insulin treatment patients where resting energy expenditure increased by 448.9 ± 216.4 kcal/m2/day (p = 0.03). Conclusion: Intensive insulin therapy, which controls blood glucose concentrations between 80 mg/dl and 110 mg/dl, attenuates the hypermetabolic stress response in the severely burned pediatric population as reflected by improvements in resting energy expenditure. Table 1Demographics of Treatment Groups. Intensive Conventional Age 5.4 ± 1.4 7.7 ± 1.2 % TBSA 62 ± 4.7 68.6 ± 3.7 % 3rd 55.7 ± 5.2 63.7 ± 5.9 Total 9 11 Open table in a new tab