NDLI: Bacterial respiratory tract infections are promoted by systemic hyperglycemia after severe burn injury in pediatric patients.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Kraft, Robert Herndon, David N. Mlcak, Ronald P. Finnerty, Celeste C. Cox, Robert A. Williams, Felicia N. Jeschke, Marc G.
Description	Country affiliation: Germany Author Affiliation: Kraft R ( Department of Trauma, Klinikum Memmingen, Germany.); Herndon DN ( Shriners Hospitals for Children, Galveston, TX, United States); Mlcak RP ( Shriners Hospitals for Children, Galveston, TX, United States.); Finnerty CC ( Shriners Hospitals for Children, Galveston, TX, United States); Cox RA ( Shriners Hospitals for Children, Galveston, TX, United States.); Williams FN ( Shriners Hospitals for Children, Galveston, TX, United States.); Jeschke MG ( Department of Surgery, Division of Plastic Surgery, Department of Immunology, Ross Tilley Burn Centre - Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, ON, Canada. Electronic address: marc.jeschke@sunnybrook.ca.)
Abstract	BACKGROUND: Burns are associated with hyperglycemia leading to increased incidence of infections with pneumonia being one of the most prominent and adverse complications. Recently, various studies in critically ill patients indicated that increased pulmonary glucose levels with airway/blood glucose threshold over 150 mg/dl lead to an overwhelming growth of bacteria in the broncho-pulmonary system, subsequently resulting in an increased risk of pulmonary infections. The aim of the present study was to determine whether a similar cutoff value exists for severely burned pediatric patients. METHODS: One-hundred six severely burned pediatric patients were enrolled in the study. Patients were divided in two groups: high (H) defined as daily average glucose levels >75% of LOS >150 mg/dl), and low (L) with daily average glucose levels >75% of the LOS <150 mg/dl). Incidences of pneumonia, atelectasis, and acute respiratory distress syndrome (ARDS) were assessed. Incidence of infections, sepsis, and respiratory parameters were recorded. Blood was analyzed for glucose and insulin levels. Statistical analysis was performed using Student's t-test and chi-square test. Significance was set at p<0.05. RESULTS: Patient groups were similar in demographics and injury characteristics. Pneumonia in patients on the mechanical ventilation (L: 21%, H: 32%) and off mechanical ventilation (L: 5%, H: 15%), as well as ARDS were significantly higher in the high group (L: 3%, H: 19%), p<0.05, while atelectasis was not different. Patients in the high group required significantly longer ventilation compared to low patients (p<0.05). Furthermore, incidence of infection and sepsis were significantly higher in the high group, p<0.05. CONCLUSION: Our results indicate that systemic glucose levels over 150 mg/dl are associated with a higher incidence of pneumonia confirming the previous studies in critically ill patients.
File Format	HTM / HTML
ISSN	03054179
e-ISSN	18791409
DOI	10.1016/j.burns.2013.07.007
Journal	Burns
Issue Number	3
Volume Number	40
Language	English
Publisher	Elsevier
Publisher Date	2014-05-01
Publisher Place	Netherlands
Access Restriction	Open
Subject Keyword	Discipline Traumatology Burns Metabolism Glucose Hyperglycemia Pneumonia, Bacterial Adolescent Complications Burns, Inhalation Child, Preschool Infant Injury Severity Score Etiology Respiratory Distress Syndrome, Adult Respiratory Tract Infections Sepsis Research Support, N.i.h., Extramural Research Support, Non-u.s. Gov't
Content Type	Text
Resource Type	Article
Subject	Emergency Medicine Surgery Critical Care and Intensive Care Medicine

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