Outcomes of Children With Diabetic Ketoacidosis Necessitating Tracheal Intubation

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Critical Care Medicine





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Introduction: Diabetic ketoacidosis (DKA) occurs in 25-40% of children with type 1 diabetes mellitus. One of the most dangerous complications of DKA is cerebral edema, occurring in 0.25% to 1% of pediatric DKA episodes, and is associated with mortality in 21% to 60% of cases. Treatment of symptomatic increased intracranial pressure (ICP) from DKA with cerebral edema has traditionally been with the initial administration of hyperosmolar therapy, as well as tracheal intubation with judicious use of hyperventilation and targeted partial pressure of carbon dioxide. Given the relative infrequency of these cases, we sought to quantify the retrospective usage of ICP monitoring and use of tracheal intubation, utilizing a national database of pediatric intensive care unit (PICU) patients. Methods: This was a retrospective chart review of de-identified data from all children between 1 day old and 18 years of age admitted to any PICU participating in the Virtual Pediatric Systems (VPS) database. Any child admitted between the years of 2010-2016 was included if designated with a primary diagnosis of DKA. Demographics were analyzed and reported and comparisons were performed between the complete report of patients with DKA and those requiring mechanical ventilation (MV) or ICP monitoring. Results: A total of 34,282 unique DKA admissions were analyzed. Of these, 1.52% required mechanical ventilation (MV), and 0.05% had ICP monitoring. A larger percentage of the MV cohort was between 1 and 23 months of age, when compared with the non-MV cohort. Mean PRISM-3 scores were higher in the MV cohort (14.8 versus 6.4). Lowest mean serum pH revealed significantly greater acidosis in the MV cohort (7.02 versus 7.14), and highest serum sodium was significantly higher in the MV cohort (151.8 vs 143.6). 19.6% patients in the MV cohort with GCS reported had a worst GCS of 3 during the first 12 hours of their admission. 5.4% of the MV cohort required cardiopulmonary resuscitation at some point prior to their PICU admission and 12.7% of patients in the MV cohort were declared brain dead during their PICU stay, versus 0% in the non-MV cohort. Conclusions: DKA is common in diabetic children, however it rarely leads to tracheal intubation. Children who require intubation are at high risk of dying in the PICU.





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