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

Robert Kraft, David Herndon, Ronald P. Mlcak, Celeste Finnerty, Robert A. Cox, Felicia N. Williams, Marc G. Jeschke

Research output: Contribution to journalArticle

16 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)428-435
Number of pages8
JournalBurns
Volume40
Issue number3
DOIs
StatePublished - 2014

Fingerprint

Respiratory Tract Infections
Hyperglycemia
Pediatrics
Wounds and Injuries
Pneumonia
Glucose
Incidence
Pulmonary Atelectasis
Adult Respiratory Distress Syndrome
Artificial Respiration
Critical Illness
Lung
Sepsis
Infection
Chi-Square Distribution
Burns
Ventilation
Blood Glucose
Demography
Insulin

Keywords

  • Airway glucose threshold
  • Bacterial growth
  • Hyperglycemia
  • Pneumonia
  • Respiratory tract infections

ASJC Scopus subject areas

  • Emergency Medicine
  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this

Bacterial respiratory tract infections are promoted by systemic hyperglycemia after severe burn injury in pediatric patients. / Kraft, Robert; Herndon, David; Mlcak, Ronald P.; Finnerty, Celeste; Cox, Robert A.; Williams, Felicia N.; Jeschke, Marc G.

In: Burns, Vol. 40, No. 3, 2014, p. 428-435.

Research output: Contribution to journalArticle

Kraft, Robert ; Herndon, David ; Mlcak, Ronald P. ; Finnerty, Celeste ; Cox, Robert A. ; Williams, Felicia N. ; Jeschke, Marc G. / Bacterial respiratory tract infections are promoted by systemic hyperglycemia after severe burn injury in pediatric patients. In: Burns. 2014 ; Vol. 40, No. 3. pp. 428-435.
@article{68f0effb5c5742a58092be13ac30bb40,
title = "Bacterial respiratory tract infections are promoted by systemic hyperglycemia after severe burn injury in pediatric patients",
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.",
keywords = "Airway glucose threshold, Bacterial growth, Hyperglycemia, Pneumonia, Respiratory tract infections",
author = "Robert Kraft and David Herndon and Mlcak, {Ronald P.} and Celeste Finnerty and Cox, {Robert A.} and Williams, {Felicia N.} and Jeschke, {Marc G.}",
year = "2014",
doi = "10.1016/j.burns.2013.07.007",
language = "English (US)",
volume = "40",
pages = "428--435",
journal = "Burns",
issn = "0305-4179",
publisher = "Elsevier Limited",
number = "3",

}

TY - JOUR

T1 - Bacterial respiratory tract infections are promoted by systemic hyperglycemia after severe burn injury in pediatric patients

AU - Kraft, Robert

AU - Herndon, David

AU - Mlcak, Ronald P.

AU - Finnerty, Celeste

AU - Cox, Robert A.

AU - Williams, Felicia N.

AU - Jeschke, Marc G.

PY - 2014

Y1 - 2014

N2 - 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.

AB - 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.

KW - Airway glucose threshold

KW - Bacterial growth

KW - Hyperglycemia

KW - Pneumonia

KW - Respiratory tract infections

UR - http://www.scopus.com/inward/record.url?scp=84896091979&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84896091979&partnerID=8YFLogxK

U2 - 10.1016/j.burns.2013.07.007

DO - 10.1016/j.burns.2013.07.007

M3 - Article

C2 - 24074819

AN - SCOPUS:84896091979

VL - 40

SP - 428

EP - 435

JO - Burns

JF - Burns

SN - 0305-4179

IS - 3

ER -