欧洲儿科重症监护室的体外血液净化:一个共识声明
Gabriella Bottari1, Emanuele Buccione2, Benan Bayrakci3
1Pediatric Intensive Care Unit, Bambino Gesù Children's Hospital, Rome, Italy.
JAMA network open
|February 3, 2025
概括
儿科重症监护中的体外血液净化疗法 (EBPT) 缺乏指导方针,导致各种做法. 专家共识强调持续置换疗法和血交换是关键的EBPT,指导未来的研究和临床决策.
科学领域:
- 儿科重症监护医学 儿科重症监护医学
- 身体以外的治疗方法
- 生物材料科学 生物材料科学
背景情况:
- 身体外血液净化疗法 (EBPT) 的进展受到既定临床指导方针的缺乏所阻碍,导致实践的显著变化.
- 儿科重症监护室 (PICU) 面临着EBPT的独特挑战,因为患者数量少,诊断多样化,技术困难,增加不良事件的风险.
研究的目的:
- 收集经验丰富的EBPT用户对关键问题的见解.
- 为未来研究研究的设计提供信息.
- 引导EBPT在儿科患者护理中的应用.
主要方法:
- 在PubMed和Embase (2020年1月 - 2024年7月) 进行了文献搜索.
- 基于Delphi的修改模型被用于在2022年至2024年之间在15名专家小组成员 (作者和儿科密集医生) 之间制定共识声明.
- 在PICU中使用EBPT的问卷,包括指示,停止标准和结果评估,使用SurveyMonkey进行分发和分析.
主要成果:
- 从8个欧洲国家的小组成员收集了116份调查答复.
- 在24个问题中,在6个问题上达成了强大的共识 (>90%的同意),在18个问题上达成了共识 (75%-90%的同意).
- 连续脏替代疗法 (CRRT) 血过器和血交换被确定为最常用的EBPT,尽管对血吸吸收的证据仍然有限.
结论:
- 本共识声明为重症儿科患者提供EBPT专家指导,特别是在临床证据稀缺的情况下.
- 这些发现旨在支持儿科重症医生在床边做出明智的决策.
- 这种共识可以指导PICU中EBPT的未来研究重点.
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