Figure Figure11 shows estimated numbers of physicians at each center that always, sometimes, or never treat critically ill children with hyperglycemia. Overall, no FTY720 purchase center reported that all of their physicians either always or never practice glycemic control. Approximately 35% of centers reported that most of their physicians always practice glycemic control, while 7% reported that most of their physicians never practice glycemic control. When broken down by ICU size, a proportionately higher number of small ICUs (<12 beds) were more likely to report that all or most of their physicians practice some type of glycemic control all or most of the time, and were more likely to report that few or none of their physicians never practice glycemic control (P < 0.05) (Figure (Figure1).1).

Half of the centers stated that for some of their physicians, the decision to treat hyperglycemia depended upon diagnosis, illness severity, and duration and severity of hyperglycemia. While most centers did not specify any agreed upon center-wide exclusions for glycemic management, three centers reported that they exclude infants and/or patients weighing <5 kg. Taken together, this data strongly indicate a large variation between glycemic control practices between pediatric ICUs, individual practitioners in any particular pediatric ICU, and at times even in the practice of any given physician.Figure 1Pediatric intensivist actual glycemic control practice habits. Centers were queried regarding what percentage of practitioners always practice glycemic control, sometimes practice glycemic control, or never practice glycemic in all, most, some, few, and .

..At present there is no consensus in critical care (adults or pediatrics) regarding the definition of hyperglycemia in critical illness. Figure Figure22 demonstrates that there is a wide variety of definitions of hyperglycemia employed at different pediatric centers. The BG above which pediatric critical care intensivists considered patients to be hyperglycemic ranged from 6 to 11 mmol/L (110 to 200 mg/dL), with most centers (>50%) defining a BG cut-off between 7.7 to 8.8 mmol/L (140 to 160 mg/dL). Large (>30 beds) ICUs were more likely to report a BG cut-off >9.9 mmol/L (180 mg/dL) (Figure (Figure2).2). For physicians that do treat hyperglycemia, BG target ranges varied anywhere from a lower glucose limit of 3.

8 mmol/L (70 mg/dL) to a maximum goal of 8.8 Cilengitide mmol/L (200 mg/dL). A goal range of 4.4 to 7.7 mmol/L (80 to 140 mg/dL) was the most consistent single target range reported (18/30 centers).Figure 2Level of blood glucose to define hyperglycemia in different ICUs. Centers were queried regarding their definition of hyperglycemia. Small ICU = <12 beds, Medium ICU = 12 to 30 beds, Large ICU = >30 beds. ICU = intensive care unit.Centers were also asked what BG level they considered to be too low in critically ill children.