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In adult intensive care units (ICUs), intensive insulin therapy remains controversial; the randomized trial with the most impressive outcomes involved mainly cardiac-surgery patients (JW Nov 16 2001). In pediatric ICUs, hyperglycemia has been associated with adverse outcomes, but no randomized trial of intensive insulin therapy has been published.
Investigators at a single pediatric ICU in Belgium randomized 700 children (45% younger than 1 year; 75% recovering from cardiac surgery) to intensive insulin infusion therapy (targeted to maintain age-adjusted normal fasting glucose values: 50–79 mg/dL in infants; 70–99 mg/dL in children) or to standard therapy (targeted to maintain glucose at <214 mg/dL). Arterial blood glucose was measured every…