A review of the evidence for glycemic control in critically ill children

Hyperglycemia in critically ill patients is quite common and has been consistently associated with increased morbidity and mortality. Controlling hyperglycemia with intensive insulin therapy, while initially promising, has yielded conflicting results. The cardiac surgical patient appears to be the subset of patients in which the greatest impact in survival has been achieved in both diabetic and non-diabetic adults. The evidence for glycemic control in critically ill children continues to evolve. The pediatric patient presents unique challenges to glycemic control in that normal glucose values vary with age and there is a greater risk of severe hypoglycemia associated with intensive insulin therapy which may have unfavorable consequences on the developing nervous system. We review the evidence for intensive insulin therapy in critically ill adults and children, with a specific concentration on the postoperative pediatric cardiac patient.