动脉导管放置的实践变化:对儿科重症监护医生的调查
Mary S Pilarz1,2, Christopher D Mattson1,2, Cara M Pritchett1,2
1Division of Critical Care, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
Journal of intensive care medicine
|September 1, 2025
概括
尽管存在指导方针,但儿科重症监护医生在动脉导管安置实践,包括技术和指示方面存在很大差异. 需要进一步的研究来规范超声波的使用和改善患者的结果.
科学领域:
- 儿童重症监护医疗
- 医疗器械的放置
- 临床实践的变化
背景情况:
- 关于动脉导管 (AC) 在重症监护中的适用性缺乏共识.
- 没有明确的证据将AC使用与改善患者的结果联系起来.
- 在儿童重症监护室 (PICU) 中,AC利用率显著变化,与患者的严重程度无关.
研究的目的:
- 调查儿科重症监护医生的动脉导管安置实践.
- 识别有关交流使用的技术,指示和态度的变化.
- 描述儿童重症监护室当前的实践情况.
主要方法:
- 匿名的,跨界的网络调查.
- 从93个机构的377名儿童重症监护医生收集的数据.
- 询问了动脉导管安置的技术,选址和指示.
主要成果:
- 在实习期间使用超声波报告了52.0%的受访者,奖学金使用它比护理人员更多.
- 塞尔丁格技术 (导管过线) 是主要的插入方法 (88.1%).
- 分别为周围和中央管道的偏好是半径动脉 (97. 3%) 和大腿动脉 (81. 1%). 在适应症方面存在显著的差异,其中68. 9%的人表示单一的血管活性支持.
结论:
- 即使在现有的指导方针中,儿童重症监护室的临床医生仍然在动脉导管放置方面存在广泛的实践差异.
- 关于超声指导技术和固定方法的证据缺口需要进一步调查.
- 通过研究优化实践对于改善儿童重症监护的患者结果至关重要.
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