| Glucose control in severely thermally injured pediatric patients: what glucose range should be the target? | |
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MedLine Citation:
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PMID: 20739853 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: To determine which glucose levels are associated with improved morbidity and mortality in thermally injured patients. SUMMARY BACKGROUND DATA: Tight euglycemic control was rapidly implemented in intensive care units around the world, but there is increasing evidence that tight euglycemic control is associated with detrimental outcomes. Currently, no study exists that indicates which glucose range should be targeted. METHODS: Two-hundred and eight severely burned pediatric patients with burns over 30% of their total body surface area were included in this trial. Several statistical models were used to determine the daily average and 6 AM glucose target that were associated with improved morbidity and mortality. Patients were then divided into good glucose controlled and poor glucose controlled patients and demographics, clinical outcomes, infection, sepsis, inflammatory, and hypermetabolic responses were determined. RESULTS: Statistical modeling showed that hyperglycemia is a strong predictor of adverse hospital outcome and that daily 6 am glucose level of 130 mg/dL and daily average glucose levels of 140 mg/dL are associated with improved morbidity and mortality postburn. When patients were divided into good glucose control and poor glucose control, we found that patients with glucose levels of 130 mg/dL exert attenuated hypermetabolic and inflammatory responses, as well as significantly lower incidence of infections, sepsis, and mortality compared with patients with poor glucose control, P < 0.05. CONCLUSIONS: Given the controversy over glucose range, glucose target, and risks and detrimental outcomes associated with hypoglycemia we suggest that in severely burned patient's blood glucose of 130 mg/dL should be targeted. |
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Authors:
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Marc G Jeschke; Robert Kraft; Fatemeh Emdad; Gabriela A Kulp; Felicia N Williams; David N Herndon |
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Publication Detail:
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Type: Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Annals of surgery Volume: 252 ISSN: 1528-1140 ISO Abbreviation: Ann. Surg. Publication Date: 2010 Sep |
Date Detail:
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Created Date: 2010-08-26 Completed Date: 2010-09-28 Revised Date: 2011-10-28 |
Medline Journal Info:
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Nlm Unique ID: 0372354 Medline TA: Ann Surg Country: United States |
Other Details:
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Languages: eng Pagination: 521-7; discussion 527-8 Citation Subset: AIM; IM |
Affiliation:
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Shriners Hospitals for Children, Biochemistry and Molecular Biology, Galveston, TX, USA. majeschk@utmb.edu |
| Data Bank Information | |
Bank Name/Acc. No.:
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ClinicalTrials.gov/NCT00673309 |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Blood Glucose
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metabolism* Burns / blood*, complications, mortality Calorimetry, Indirect Child Chromatography, High Pressure Liquid Female Humans Hyperglycemia / blood*, etiology, mortality Hypoglycemia / blood*, etiology, mortality Insulin Resistance Intensive Care Units / standards Male Models, Statistical Nephelometry and Turbidimetry Predictive Value of Tests |
| Grant Support | |
ID/Acronym/Agency:
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H133A020102//PHS HHS; H133A70019//PHS HHS; KO1-HL70451/HL/NHLBI NIH HHS; P50 GM60338/GM/NIGMS NIH HHS; R01-GM56687/GM/NIGMS NIH HHS; R01-HD049471/HD/NICHD NIH HHS; T32 GM008256/GM/NIGMS NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Blood Glucose |
| Comments/Corrections | |
Comment In:
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Ann Surg. 2011 Oct;254(4):671-2; author reply 672-3
[PMID:
21946223
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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