Nottingham University Hospital, UK.
Arch Dis Child. 2010 Sep;95(9):681-5. doi: 10.1136/adc.2008.151266. Epub 2009 Aug 9.
To describe current practice during stabilisation of children presenting with critical illness to the district general hospital (DGH), preceding retrieval to intensive care.
Observational study using prospectively collected transport data.
A centralised intensive care retrieval service in England and referring DGHs.
Emergency transports to intensive care during 2-month epochs from 4 consecutive years (2005-2008).
None.
Proportion of key airway, breathing, and circulatory and neurological stabilisation procedures, such as endotracheal intubation, mechanical ventilation, vascular access, and initiation of inotropic agents, performed by referring hospital staff prior to the arrival of the retrieval team.
706 emergency retrievals were examined over a 4-year period. The median age of transported children was 10 months (IQR, 18 days to 43 months). DGH staff performed the majority of endotracheal intubations (93.7%, CI 91.3% to 95.5%), initiated mechanical ventilation in 76.9% of cases (CI 73.0% to 80.4%), inserted central venous catheters frequently (67.4%, CI 61.7% to 72.6%), and initiated inotropic agents in 43.7% (CI 36.6% to 51.1%). The retrieval team was more likely to perform interventions such as reintubation for air leak, repositioning of misplaced tracheal tubes, and administration of osmotic agents for raised intracranial pressure. The performance of one or more interventions by the retrieval team was associated with severity of illness, rather than patient age, diagnostic group, or team response time (OR 3.62, 95% CI 1.47 to 8.92).
DGH staff appropriately performs the majority of initial stabilisation procedures in critically ill children prior to retrieval. This practice has not changed significantly for the past 4 years, attesting to the crucial role played by district hospital staff in a centralised model of paediatric intensive care.
描述在将儿童送往地区综合医院（DGH）进行重症监护之前，在稳定期的当前实践情况，以便进行重症监护。
使用前瞻性收集的转运数据进行观察性研究。
英国集中式重症监护转运服务和转诊 DGH。
连续 4 年（2005-2008 年）每两个月进行一次重症监护转运的患者。
无。
由转诊医院工作人员在转运团队到达之前进行的关键气道、呼吸、循环和神经稳定程序的比例，例如气管插管、机械通气、血管通路和开始使用正性肌力药物。
在 4 年期间共检查了 706 例紧急转运患者。转运儿童的中位年龄为 10 个月（IQR，18 天至 43 个月）。DGH 工作人员进行了大多数气管插管（93.7%，CI 91.3%至 95.5%），76.9%的病例开始机械通气（CI 73.0%至 80.4%），经常插入中心静脉导管（67.4%，CI 61.7%至 72.6%），43.7%的患者开始使用正性肌力药物（CI 36.6%至 51.1%）。转运团队更有可能进行干预，例如因漏气重新插管、重新定位错位的气管插管以及使用渗透性药物治疗颅内压升高。转运团队进行一项或多项干预与疾病严重程度相关，而不是与患者年龄、诊断组或团队反应时间相关（OR 3.62，95%CI 1.47 至 8.92）。
在进行重症监护之前，DGH 工作人员在将儿童送往地区综合医院时适当地进行了大多数初始稳定化程序。在过去的 4 年中，这种做法没有明显变化，这证明了地区医院工作人员在集中式儿科重症监护模式中发挥的关键作用。
