Hyperglycemia heightens pneumonia risk in pediatric burns patients

Oct 8 2013

Research indicates that hyperglycemia puts pediatric burns patients at increased risk for pneumonia.

The study included 106 patients aged up to 17 years old with over 30% total burn surface area participating in a trial of the effects of tight glycemic control after severe burn injury. Overall, 47 had a glucose level of over 150 mg/dL – a threshold previously found to be associated with pulmonary bacterial overgrowth – for at least 75% of their hospital stay.

The team reports in Burns that these patients had a significantly higher incidence of sepsis (42.6 vs 15.3%) and wound infections (4.1 vs 2.7) than patients with lower glucose levels and, in turn, were more likely to die (27.7 vs 3.4%).

Patients with high glucose levels also required mechanical ventilation significantly longer than those with lower glucose levels (10 vs 3 days) and at a significantly higher maximum positive end expiratory pressure (11 vs 6 mmHg).

And, whether or not they were mechanically ventilated or had adult respiratory distress syndrome, patients in the high glucose group were significantly more likely to develop pneumonia than patients in the low glucose group, at an overall rate of 30% versus 19%. However, the incidence of atelectasis did not significantly differ between patients by glucose level and among patients with atelectasis there was no difference in pneumonia incidence according to glucose status.

Author Marc Jeschke (Sunnybrook Research Institute, Toronto, Ontario, Canada) and colleagues say that their results support previous findings that hyperglycemia leads to worsened outcomes in critically ill patients. They note that another study indicated that systemic blood glucose levels greater than 144 mg/dL lead to markedly increased glucose content in the airways.

“[A] hallmark after severe burn injury is hypermetabolism associated with hyperglycemia and insulin resistance,” the team writes.

The authors conclude: “We suggest the direct effect of glucose as a growth media for bacteria combined with altered mucus viscosity as main contributors to the development of pneumonia in hyperglycemic critically ill patients.”

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