Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
Pediatrics. 2011 Jan;127(1):42-8. doi: 10.1542/peds.2010-1336. Epub 2010 Dec 20.
The "golden-hour" concept has led to emphasis on speed of patient delivery during pediatric interfacility transport. Timely intervention, in addition to enhanced monitoring during transport, is the key to improved outcomes in critically ill patients. Taking the ICU to the patient may be more beneficial than rapid delivery to a tertiary care center.
The Improved Monitoring During Pediatric Interfacility Transport trial was the first randomized controlled trial in the out-of-hospital pediatric transport environment. It was designed to determine the impact of improved blood pressure monitoring during pediatric interfacility transport and the effect on clinical outcomes in patients with systemic inflammatory response syndrome and moderate-to-severe head trauma. Patients in the control group had their blood pressure monitored intermittently with an oscillometric device; those in the intervention group had their blood pressure monitored every 12 to 15 cardiac contractions with a near-continuous, noninvasive device.
Between May 2006 and June 2007, 1995, consecutive transport patients were screened, and 94 were enrolled (48 control, 46 intervention). Patients in the intervention group received more intravenous fluid (19.8 ± 22.2 vs 9.9 ± 9.9 mL/kg; P = .01), had a shorter hospital stay (6.8 ± 7.8 vs 10.9 ± 13.4 days; P = .04), and had less organ dysfunction (18 of 206 vs 32 of 202 PICU days; P = .03).
Improved monitoring during pediatric transport has the potential to improve outcomes of critically ill children. Clinical trials, including randomized controlled trials, can be accomplished during pediatric transport. Future studies should evaluate optimal equipment, protocols, procedures, and interventions during pediatric transport, aimed at improving the clinical and functional outcomes of critically ill patients.
“黄金时段”的概念导致人们强调儿科医院间转运过程中患者的运送速度。除了在转运过程中加强监测外，及时干预是改善危重症患者预后的关键。将 ICU 带到患者身边可能比将患者迅速送往三级护理中心更有益。
在院外儿科转运环境中，首次进行了“改善儿科医院间转运期间监测”的随机对照试验。该试验旨在确定改善儿科医院间转运期间血压监测对全身炎症反应综合征和中重度颅脑创伤患者的临床结局的影响。对照组患者间歇性使用示波法监测血压；干预组患者每 12-15 次心脏收缩使用连续无创设备监测血压。
2006 年 5 月至 2007 年 6 月期间，对 1995 例连续转运患者进行了筛查，其中 94 例患者入选（对照组 48 例，干预组 46 例）。干预组患者接受了更多的静脉输液（19.8±22.2 比 9.9±9.9 mL/kg；P=0.01），住院时间更短（6.8±7.8 比 10.9±13.4 天；P=0.04），器官功能障碍更少（206 个 PICU 天中 18 例，202 个 PICU 天中 32 例；P=0.03）。
在儿科转运期间进行更有效的监测可能会改善危重症儿童的结局。临床试验，包括随机对照试验，都可以在儿科转运过程中进行。未来的研究应评估儿科转运期间的最佳设备、方案、程序和干预措施，旨在改善危重症患者的临床和功能结局。
