儿童败血症和败血性休克的国际共识标准
Luregn J Schlapbach1,2, R Scott Watson3,4, Lauren R Sorce5,6
1Department of Intensive Care and Neonatology, and Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland.
JAMA
|January 21, 2024
概括
新的儿科败血症标准, 败血症评分, 识别了感染儿童的危及生命的器官功能障碍. 这一分数可以改善儿童败血症和败血性休克的全球临床治疗和研究.
科学领域:
- 儿童重症监护医疗
- 感染性疾病
- 公共卫生
背景情况:
- 败血症是全球儿童死亡的主要原因.
- 现有的儿科败血症标准 (2005年) 已经过时,缺乏预测准确性.
- 败血症-3定义不包括儿童,因此需要更新儿童特异性指南.
研究的目的:
- 制定和验证用于识别儿童的败血症和败血性休克的最新标准.
- 建立一个更准确和临床相关的儿童败血症定义.
主要方法:
- 召集了一个国际儿科专家工作组 (重症监护医学协会).
- 通过国际调查,使用了经过修改的德尔菲共识过程.
- 分析了大量数据 (>300万次EHR遭遇) 以开发和验证毒性评分.
主要成果:
- 性败血症评分 (≥2) 识别了疑似感染和危及生命的器官功能障碍的儿童.
- 符合Phoenix标准的儿童在住院死亡率明显高 (资源较高的7.1%,资源较低的28.5%).
- 在儿童中,败血症是由心血管功能障碍 (例如低血压,高乳酸,血管压力剂) 所定义的.
结论:
- 菲尼克斯败血症标准为儿童败血症和败血症休克提供了经过验证的,基于证据的方法.
- 在全球范围内实施性败血症评分可以提高临床护理,流行病学研究和研究.
- 这些标准代表了全球儿童败血症管理的重大进步.
更多相关视频
相关概念视频
01:24Blood Pressure Imbalances and Circulatory Shock
1.8K
Disorders affecting blood volume, vascular tone, or vascular function can disrupt vascular homeostasis, including conditions like hypertension, hemorrhage, and shock.
Blood Pressure: Hypertension and Hypotension
Normal blood pressure is 120/80 mm Hg. Elevated blood pressure is 120-129/under 80 mm Hg. Hypertension, warranting treatment at 130/80 mm Hg, is often asymptomatic and can lead to severe cardiovascular events, aneurysms, peripheral arterial disease, chronic renal disease, or cardiac...
Blood Pressure: Hypertension and Hypotension
Normal blood pressure is 120/80 mm Hg. Elevated blood pressure is 120-129/under 80 mm Hg. Hypertension, warranting treatment at 130/80 mm Hg, is often asymptomatic and can lead to severe cardiovascular events, aneurysms, peripheral arterial disease, chronic renal disease, or cardiac...
1.8K
01:30Pneumonia III: Complications and Assessment
1.4K
Pneumonia poses the potential for numerous complications that warrant consideration. These complications include the following:
1.4K
01:29Acute Kidney Injury III: Clinical Manifestations
1.8K
Acute Kidney Injury (AKI) progresses through distinct clinical phases: the oliguric, diuretic, and recovery phases, each marked by unique manifestations and challenges.Oliguric Phase:The oliguric phase is the initial stage of AKI, typically lasting 10 to 14 days. This phase is marked by a significant reduction in urine output, usually less than 400 mL per day, indicating decreased kidney function. Fluid retention is a prominent feature, leading to symptoms such as edema, hypertension, and...
1.8K
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
582
Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...
582
01:20Acute Kidney Injury V: Interprofessional Care
548
Acute Kidney Injury (AKI) requires a collaborative healthcare approach to restore renal function and prevent complications. Essential management strategies involve monitoring fluid and electrolyte balance, adjusting medications, initiating dialysis when necessary, and providing nutritional support.Fluid and Electrolyte ManagementFluid Monitoring: Regularly monitoring body weight, central venous pressure, and urine output helps detect fluid imbalances early. Patient intake and output are...
548