在支气管炎中适当使用高流量鼻:德尔菲方法
Clea D Harris1,2, Jennifer D Treasure3,4, Kimberly Albanowski5
1Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Hospital pediatrics
|December 7, 2025
概括
国家专家制定了关于在儿科支气管炎中使用高流量鼻管 (HFNC) 的指导方针. 这些建议旨在规范护理并优化需要呼吸辅助的儿童的治疗结果.
科学领域:
- 儿科肺病学 儿科肺病学
- 临界护理医学 临界护理医学
- 基于证据的医学基于证据的医学.
背景情况:
- 在国家使用高流量鼻腔管 (HFNC) 治疗儿科支气管炎方面存在显著差异.
- 现有的文献支持特定的HFNC实践,但临床应用仍然不一致.
研究的目的:
- 制定基于证据的建议,以适当和必要地使用HFNC在患有支气管炎的住院儿童中.
- 为了规范HFNC的使用,并改善患者的治疗结果.
主要方法:
- 采用RAND/UCLA适当性方法,包括广泛的文献审查.
- 召集了一个多学科专家小组 (护理,呼吸疗法,医学),具有多样化的临床专业知识.
- 举办了三次评级会议和一个由小组成员主持的会议,以评估建议.
主要成果:
- 一个由15名成员组成的小组评估了HFNC启动,重新评估,升级和缓解支气管炎的60条建议.
- 在60条建议中,有52条关于适当性,有52条关于必要性达成协议.
- 关键协议包括启动HFNC治疗耐火性低氧症/即将出现的呼吸衰竭,特定流量 (1.5-2 L/kg/分钟) 和停止标准.
结论:
- 国家专家就儿童支气管炎HFNC参数的适当性和必要性达成共识.
- 这些标准化建议可以优化临床实践,减少非特定的HFNC应用.
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