OBJECTIVES: To assess the willingness of pediatric intensivists to conduct a pediatric trial of blood glucose control, and to determine if self-reported practices were influenced by adult-specific data over the past 4 yrs. This was a follow-up to our previous 2005 survey. DESIGN: Electronic survey comprising a 30-item questionnaire. SETTING: North American PICUs that were members of, or connected to, the Pediatric Acute Lung Injury and Sepsis Network (n = 96 targeted institutions). PARTICIPANTS: North American pediatric intensivists (n = 209). INTERVENTIONS: None. METHODS: We conducted a survey of North American PICUs using a Web-based questionnaire. Invitations were sent to 96 institutions in 37 states/provinces. RESULTS: Response rate was 68% (141/209). The median definitions of hyperglycemia (150 mg/dL) and hypoglycemia (≤60 mg/dL) were similar to our 2005 survey results. Self-reported practice patterns remain variable. Although 75% of clinician respondents denied a change in clinical practice based on the published literature, the preferred blood glucose target range increased from 80-110 mg/dL in 2005 to 90-140 mg/dL in 2009. Intensivists who preferred a blood glucose target of 80-110 mg/dL decreased from 43% to 6% (p < 0.001). Many respondents (45%) indicated that the acceptable severe hypoglycemia rate (% patients) for a protocol was ≤2.5%. The majority (93%) indicated they would be willing to enroll patients in a pediatric trial of blood glucose control. CONCLUSIONS: Pediatric intensivists report that they control blood glucose with insulin in critically ill children and do not necessarily adopt adult-specific data or a single uniform blood glucose target. The published evidence does not adequately address PICU clinicians concerns. Unanswered questions and persistent variation in practice suggest a need for a multicenter clinical trial of blood glucose control in critically ill children.
OBJECTIVES: To assess the willingness of pediatric intensivists to conduct a pediatric trial of blood glucose control, and to determine if self-reported practices were influenced by adult-specific data over the past 4 yrs. This was a follow-up to our previous 2005 survey. DESIGN: Electronic survey comprising a 30-item questionnaire. SETTING: North American PICUs that were members of, or connected to, the Pediatric Acute Lung Injury and Sepsis Network (n = 96 targeted institutions). PARTICIPANTS: North American pediatric intensivists (n = 209). INTERVENTIONS: None. METHODS: We conducted a survey of North American PICUs using a Web-based questionnaire. Invitations were sent to 96 institutions in 37 states/provinces. RESULTS: Response rate was 68% (141/209). The median definitions of hyperglycemia (150 mg/dL) and hypoglycemia (≤60 mg/dL) were similar to our 2005 survey results. Self-reported practice patterns remain variable. Although 75% of clinician respondents denied a change in clinical practice based on the published literature, the preferred blood glucose target range increased from 80-110 mg/dL in 2005 to 90-140 mg/dL in 2009. Intensivists who preferred a blood glucose target of 80-110 mg/dL decreased from 43% to 6% (p < 0.001). Many respondents (45%) indicated that the acceptable severe hypoglycemia rate (% patients) for a protocol was ≤2.5%. The majority (93%) indicated they would be willing to enroll patients in a pediatric trial of blood glucose control. CONCLUSIONS: Pediatric intensivists report that they control blood glucose with insulin in critically ill children and do not necessarily adopt adult-specific data or a single uniform blood glucose target. The published evidence does not adequately address PICU clinicians concerns. Unanswered questions and persistent variation in practice suggest a need for a multicenter clinical trial of blood glucose control in critically ill children.
Authors: Eliotte L Hirshberg; Michael J Lanspa; Emily L Wilson; Katherine A Sward; Al Jephson; Gitte Y Larsen; Alan H Morris Journal: Diabetes Technol Ther Date: 2017-03-01 Impact factor: 6.118
Authors: Michael S D Agus; David Wypij; Eliotte L Hirshberg; Vijay Srinivasan; E Vincent Faustino; Peter M Luckett; Jamin L Alexander; Lisa A Asaro; Martha A Q Curley; Garry M Steil; Vinay M Nadkarni Journal: N Engl J Med Date: 2017-01-24 Impact factor: 91.245
Authors: Michael Sd Agus; Ellie Hirshberg; Vijay Srinivasan; Edward Vincent Faustino; Peter M Luckett; Martha Aq Curley; Jamin Alexander; Lisa A Asaro; Kerry Coughlin-Wells; Donna Duva; Jaclyn French; Natalie Hasbani; Martha T Sisko; Carmen L Soto-Rivera; Garry Steil; David Wypij; Vinay M Nadkarni Journal: Contemp Clin Trials Date: 2016-12-30 Impact factor: 2.226
Authors: Eliotte L Hirshberg; Jamin L Alexander; Lisa A Asaro; Kerry Coughlin-Wells; Garry M Steil; Debbie Spear; Cheryl Stone; Vinay M Nadkarni; Michael S D Agus Journal: Chest Date: 2021-04-29 Impact factor: 9.410