Glycemic control in critically ill children: a review of current evidence and guidelines

Glycemic control in critically ill children is a crucial aspect of intensive care management, as both hyperglycemia and hypoglycemia are associated with increased morbidity and mortality. This review discusses the pathophysiology of critical illness-induced dysglycemia, reviews pertinent literature on critically ill children, and shares insights from adult studies. Researchers have extensively studied tight glycemic control (TGC), yet its benefits in the burn and post-surgical subgroup in the pediatric critical care population remain uncertain due to heightened risks of hypoglycemia. The TGC-FAST trial has challenged established beliefs regarding glucose management, emphasizing the complex relationship between glycemic control, parenteral nutrition, and patient outcomes. Current guidelines from the Society of Critical Care Medicine (SCCM) recommend a judicious approach, focusing on moderate glycemic control (140-200 mg/dl) to prevent severe hyperglycemia without intensive lowering. Pediatric clinicians face challenges such as heterogeneity of disease population, immature blood-brain barrier development, and variations in institutional practice.