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Intensive insulin therapy-reduced mortality in patients in paediatric intensive care

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Study design

Design

Single centre randomised controlled trial, stratified by diagnostic category and age, comparing conventional or intensive insulin treatment.

Allocation

Concealed allocation by envelopes.

Blinding

Blinding not stated.

Study question

Setting

Paediatric intensive care unit (PICU) in a Belgian University hospital.

Patients

700 critically ill children, 317 infants <1 year and 383 children >1 year.

Intervention

(1) Conventional group, insulin infusion commenced for blood glucose concentration >11.9 mmol/l twice and dose adjusted to maintain blood glucose 10.0–11.9 mmol/l. (2) Intensive insulin group, insulin infused at 0.1 U/kg/h to target age-adjusted normoglycaemia: for infants aged 0–1 year 2.8–4.4 mmol/l and for children aged 1–16 years 3.9–5.5 mmol/l. If hypoglycaemic, then infusion stopped and 50% dextrose given.

Conventional (n=351)Intensive (n=349)ARR/ARI (95% CI)
Paediatric intensive care unit mortality (30 days)5.7%2.6%3.1% (0.2% to 6.1%)
Days in ICU (mean, 95% CI)6.15 (5.25 to 7.05)5.51 (4.65 to 6.37)
Number of secondary infections129 (36.8%)102 (29.2%)7.5% (0.6% to 14.5%)
Number of patients with hypoglycaemia5 (1.4%)87 (24.9%)23.5% (18.8% to 28.2%)

Outcomes

In-hospital morbidity, PICU mortality and length of stay. C-reactive protein, duration of mechanical ventilation and vital organ support and markers of organ dysfunction were also recorded. Adverse events included hypoglycaemic episodes.

Follow-up period

Until PICU discharge.

Main results

Insulin therapy was administered in …

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