Stricker Paul A, Cladis Franklyn P, Fiadjoe John E, McCloskey John J, Maxwell Lynne G
Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
Paediatr Anaesth. 2011 Oct;21(10):1026-35. doi: 10.1111/j.1460-9592.2011.03619.x. Epub 2011 May 20.
OBJECTIVE/AIMS: To assess current practices in the management of children undergoing craniofacial surgery and identify areas of significant practice variability with the intent to direct future research.
The perioperative management of infants and children undergoing craniofacial reconstruction surgery can be challenging because of the routine occurrence of significant blood loss with associated morbidity. A variety of techniques have been described to improve the care for these children. It is presently unknown to what extent these practices are currently employed.
A web-based survey was sent to representatives from 102 institutions. One individual per institution was surveyed to prevent larger institutions from being over-represented in the results.
Requests to complete the survey were sent to 102 institutions; 48 surveys were completed. The survey was composed of two parts: management of infants undergoing strip craniectomies, and management of children undergoing major craniofacial reconstruction.
Significant variability exists in the management of children undergoing these procedures; further study is required to determine the optimal management strategies. Clinical trials assessing the utility of central venous pressure and other hemodynamic monitoring modalities would enable evidence-based decision-making for monitoring in these children. The development of institutional transfusion thresholds should be encouraged, as there exists a body of evidence supporting their efficacy and safety.
评估颅面外科手术患儿的当前管理实践，并确定存在显著实践差异的领域，以便指导未来的研究。
由于颅面重建手术患儿围手术期经常出现大量失血及相关并发症，其围手术期管理具有挑战性。已描述了多种技术来改善对这些患儿的护理。目前尚不清楚这些实践在多大程度上得到了应用。
向102家机构的代表发送了基于网络的调查问卷。每家机构仅调查一人，以防止大型机构在结果中占比过高。
向102家机构发送了完成调查问卷的请求；48份调查问卷被完成。该调查问卷由两部分组成：条状颅骨切除术患儿的管理，以及接受大型颅面重建手术患儿的管理。
在接受这些手术的患儿管理方面存在显著差异；需要进一步研究以确定最佳管理策略。评估中心静脉压和其他血流动力学监测方式效用的临床试验将有助于为这些患儿的监测做出基于证据的决策。应鼓励制定机构输血阈值，因为有大量证据支持其有效性和安全性。
