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Critical Care
Published in: Critical Care 1/2018

Open Access 01-12-2018 | Research

Tight glycemic control in critically ill pediatric patients: a systematic review and meta-analysis

Authors: Lvlin Chen, Tiangui Li, Fang Fang, Yu Zhang, Andrew Faramand

Published in: Critical Care | Issue 1/2018

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Abstract

Background

Hyperglycemia is prevalent in patients in the pediatric intensive care unit. The purpose of this study was to describe the benefits and risks of tight glucose control (TGC) in critically ill children.

Methods

A systemic review and meta-analysis of the literature was carried out on randomized controlled trials of TGC in critically ill children admitted to the pediatric intensive care unit. The databases searched were Medline, Embase, and CENTRAL databases until May 1, 2017. Paired reviewers independently screened citations, assessed risk of bias of included studies, and extracted data. A random-effects model was used to report all outcomes. The Grading of Recommendations Assessment, Development and Evaluation system was used to quantify absolute effects and quality of evidence. The primary outcome was hospital mortality. The secondary outcomes were hypoglycemia (any, severe), sepsis, new need for dialysis, and seizures.

Results

A total of 4030 patients were included from six studies. All six studies were rated as at low risk of bias. Our meta-analysis showed that TGC did not result in a decrease in risk of hospital mortality (odds ratio (OR), 0.95; 95% confidence interval (CI), 0.62–1.45; I2 = 40%; moderate quality), sepsis (OR, 0.82; 95% CI, 0.63–1.08), or seizures (OR, 0.98; 95% CI, 0.59–1.63). TGC was associated with a decrease in new need for dialysis (OR, 0.63; 95% CI, 0.45–0.86). However, TGC was associated with a significant increase in any hypoglycemia (OR, 4.39; 95% CI, 2.39–8.06) and severe hypoglycemia (OR, 4.11; 95% CI, 2.67–6.32).

Conclusions

Among critically ill children with hyperglycemia, TGC does not result in a decrease in hospital mortality, but appears to reduce a new need for dialysis. However, TGC is associated with higher incidence of hypoglycemia.

Systematic review registration

PROSPERO registration number CRD42017074039.
Appendix
Available only for authorised users
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Metadata
Title
Tight glycemic control in critically ill pediatric patients: a systematic review and meta-analysis
Authors
Lvlin Chen
Tiangui Li
Fang Fang
Yu Zhang
Andrew Faramand
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2018
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-018-1976-2

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