Tight glycemic control failed to benefit pediatric ICU patients

Tight glycemic control in critically ill children had no significant effect on the number of days alive and free from mechanical ventilation, according to researchers.

Children admitted to the pediatric ICU (aged ≤16 years) who were expected to require mechanical ventilation and vasoactive drugs for at least 12 hours were randomly assigned to tight glycemic control with a target blood glucose range of 72 mg/dL to 126 mg/dL or conventional glycemic control with a target level less than 216 mg/dL.

Besides assessing the number of days alive and free from mechanical ventilation at 30 days after random assignment, the Control of Hyperglycemia in Pediatric Intensive Care (ChiP) trial researchers examined the costs of hospital and community health services.

Of 1,369 patients at 13 centers in England, 694 were assigned to tight glycemic control and 675 to conventional glycemic control. Of those, 60% had undergone cardiac surgery, according to researchers.

Data indicate that the mean between-group difference in the number of days patients were alive and free from mechanical ventilation at 30 days was 0.36 days (95% CI, –0.42 to 1.14).

In addition, severe hypoglycemia was observed in children in the tight glycemic control group compared with those in the conventional glycemic control group (7.3% vs. 1.5%, P<.001).

The mean 12-month costs were less in the tight glycemic control group compared with the conventional glycemic control group (cost per patient difference of –$4,815; 95% CI, –$10,298 to –$668), according to data. The cardiac surgery subgroup costs were similar in each group. However, in the subgroup that did not undergo cardiac surgery, the mean cost was less in the tight glycemic control group compared with the conventional glycemic control group (–$13,120; 95% CI, −$24,682 to −$1,559), researchers wrote.

In an accompanying editorial, Michael S.D. Agus, MD, of Boston Children’s Hospital and Harvard Medical School, wrote that the trial was well designed but would require further study.

“Although the improved 1-year health care outcomes in the non–cardiac-surgery patients is compelling, it remains impossible to determine best practice for the child who requires critical care for reasons other than cardiac surgery or burns until either a meta-analysis of several trials is performed on an individual-data level or until data from an ongoing large, multicenter trial are accrued,” Agus wrote.

For more information:

Agus MSD. N Engl J Med. 2014;370;168-169.

Macrae D. N Engl J Med. 2014;370;107-118.

Disclosure: The researchers report no relevant financial disclosures. Agus reports personal fees from Medtronic and Roche and non-financial support from DexCom, Edwards Scientific and Nova Biomedical.