학술논문
Adherence to the 2015 and 2020 British Society of Paediatric Endocrinology and Diabetes guidelines and outcomes in critically ill children with diabetic ketoacidosis: a retrospective cohort study.
Document Type
Academic Journal
Author
Edwards VM; Children's Acute Transport Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.; Department of Anaesthetics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.; Procter C; Department of Paediatrics, Red Cross Children's Hospital, Cape Town, South Africa.; Jones AJ; Children's Acute Transport Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.; Randle E; Children's Acute Transport Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.; Ramnarayan P; Children's Acute Transport Service, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK p.ramnarayan@imperial.ac.uk.; Anaesthetics, Pain Medicine and Intensive Care Section, Department of Surgery, Imperial College London Faculty of Medicine, London, UK.
Source
Publisher: BMJ Pub. Group [etc.] Country of Publication: England NLM ID: 0372434 Publication Model: Electronic Cited Medium: Internet ISSN: 1468-2044 (Electronic) Linking ISSN: 00039888 NLM ISO Abbreviation: Arch Dis Child Subsets: MEDLINE
Subject
Language
English
Abstract
Objectives: To compare clinical management and key outcomes of critically ill children with diabetic ketoacidosis (DKA) in two cohorts (2015 cohort: managed according to the 2015 British Society of Paediatric Endocrinology and Diabetes (BSPED) guidelines; 2020 cohort: managed according to the 2020 BSPED guidelines).
Design: Retrospective cohort study using prospectively collected data.
Setting: A critical care advice and transport service based in London, and referring hospitals within the critical care network.
Patients: All children 0-17 years referred for advice and/or critical care transport with a clinical diagnosis of DKA over a 30-month period (from September 2018 to March 2021).
Interventions: None.
Main Outcome Measures: Admission to intensive care unit (ICU), clinically diagnosed cerebral oedema and death.
Results: There were significant differences in fluid and insulin administration practices between the 2015 and 2020 cohorts (fluid bolus >20 mL/kg: 3% vs 30%, p<0.001; median total fluid given in the first 24 hours: 84 mL/kg vs 117 mL/kg, p<0.01; starting insulin infusion rate 0.1 U/kg/hour: 54% vs 31%, p<0.01). However, these differences were consistent with guideline recommendations (initial fluid infusion rate within 5% of guideline-recommended rate: 80% in the 2015 group vs 84% in the 2020 group). There were no significant differences in outcomes (ICU admission: 26% vs 35%, p=0.2; cerebral oedema: 21% vs 23%, p=0.8).
Conclusions: Our study findings indicate that changes to fluid and insulin administration occurred after the 2020 BSPED guideline publication, with strong adherence to the guideline, but these changes were not associated with changes in key outcomes.
Competing Interests: Competing interests: None declared.
(© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)
Design: Retrospective cohort study using prospectively collected data.
Setting: A critical care advice and transport service based in London, and referring hospitals within the critical care network.
Patients: All children 0-17 years referred for advice and/or critical care transport with a clinical diagnosis of DKA over a 30-month period (from September 2018 to March 2021).
Interventions: None.
Main Outcome Measures: Admission to intensive care unit (ICU), clinically diagnosed cerebral oedema and death.
Results: There were significant differences in fluid and insulin administration practices between the 2015 and 2020 cohorts (fluid bolus >20 mL/kg: 3% vs 30%, p<0.001; median total fluid given in the first 24 hours: 84 mL/kg vs 117 mL/kg, p<0.01; starting insulin infusion rate 0.1 U/kg/hour: 54% vs 31%, p<0.01). However, these differences were consistent with guideline recommendations (initial fluid infusion rate within 5% of guideline-recommended rate: 80% in the 2015 group vs 84% in the 2020 group). There were no significant differences in outcomes (ICU admission: 26% vs 35%, p=0.2; cerebral oedema: 21% vs 23%, p=0.8).
Conclusions: Our study findings indicate that changes to fluid and insulin administration occurred after the 2020 BSPED guideline publication, with strong adherence to the guideline, but these changes were not associated with changes in key outcomes.
Competing Interests: Competing interests: None declared.
(© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)