血动力学支持儿科败血性休克:一个全球视角
Suchitra Ranjit1, Niranjan Kissoon2, Andrew Argent3
1Paediatric Intensive Care Unit, Apollo Children's Hospital, Chennai, India.
The Lancet. Child & adolescent health
|June 24, 2023
概括
儿科败血栓冲击管理需要重新评估,特别是在资源较低的环境中. 这一观点讨论了液体复苏,血管活性剂和监测,以改善全球儿科败血症护理.
科学领域:
- 儿科重症监护医学 儿科重症监护医学
- 全球健康 全球健康
- 传染性疾病 传染性疾病
背景情况:
- 感染性休克是全球儿童死亡的主要原因之一.
- 2020年小儿生存败血症运动 (SSC) 准则提供了基于证据的建议.
- 最近来自各种环境的试验,包括LMICs,为败血症管理提供了新的见解.
研究的目的:
- 在低收入和中等收入国家 (LMICs) 批判性地重新评估目前的SSC指南的应用.
- 讨论与全球环境相关的儿科败血症休克管理的关键概念,特别是LMICs.
- 突出在资源有限的环境中改善儿科败血症护理的挑战和机会.
主要方法:
- 这种观点批判性地分析了最近的临床试验数据和专家经验.
- 它侧重于三个核心领域:早期识别,初始血液动力学支持和复苏终点.
- 它结合了来自LMIC和高收入国家的见解.
主要成果:
- 对于儿科败血症休克的早期识别和最佳初始血液动力学支持仍然存在不确定性.
- 关于早期液体复苏和血管活性剂的使用存在争议,受不断变化的临床表型的影响.
- 简单,易于使用的监测工具对于在LMICs应用指南和个性化护理至关重要.
结论:
- 调整全球儿科败血症指南以适应LMIC现实是必不可少的.
- 以可访问的监测为指导的个性化血液动力学支持是关键.
- 需要进一步的研究和对话,以优化各种环境中的治疗途径.
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