Department of Pediatrics, McMaster Children's Hospital and McMaster, University, Hamilton, Ontario, Canada.
PLoS One. 2013;8(3):e58282. doi: 10.1371/journal.pone.0058282. Epub 2013 Mar 12.
Children who require fluid resuscitation for the treatment of shock present to tertiary and non-tertiary medical settings. While timely fluid therapy improves survival odds, guidelines are poorly translated into clinical practice. The objective of this study was to characterize the attitudes, preferences and beliefs of health care providers working in acute care settings regarding pediatric fluid resuscitation performance.
A single-centre survey study was conducted at McMaster Children's Hospital from January to May, 2012. The sampling frame (n = 115) included nursing staff, physician staff and subspecialty trainees working in Pediatric Emergency Medicine (PEM) or Pediatric Critical Care Medicine (PCCM). A self-administered questionnaire was developed and assessed for face validity prior to distribution. Eligible participants were invited at 0, 2, and 4 weeks to complete a web-based version of the survey. A follow-up survey administration phase was conducted to improve the response rate.
Response rate was 72.2% (83/115), with 83% (68/82) self-identifying as nursing staff and 61% (50/82) as PCCM providers. Resuscitation experience, frequency of shock management, and years in specialty, were similar between PCCM and PEM responders. Physicians and nurses had differing opinions regarding the most effective method to achieve rapid fluid resuscitation in young children presenting in shock (p<0.001). Disagreement also existed regarding the age and size of patients in whom rapid infuser devices, such as the Level-1 Rapid Infuser, should be used (p<0.001). Providers endorsed a number of potential concerns related to the use of rapid infuser devices in children, and only 14% of physicians and 55% of nursing staff felt that they had received adequate training in the use of such devices (p = 0.005).
There is a lack of consensus among health care providers regarding how pediatric fluid resuscitation guidelines should be operationalized, supporting a need for further work to define best practices.
需要接受液体复苏治疗休克的儿童会在三级和非三级医疗机构就诊。虽然及时的液体治疗可以提高生存率，但指南在临床实践中的转化情况较差。本研究的目的是描述在急症护理环境中工作的医疗保健提供者在儿科液体复苏方面的态度、偏好和信念。
2012 年 1 月至 5 月，在麦克马斯特儿童医院进行了一项单中心调查研究。抽样框架（n = 115）包括在儿科急诊医学（PEM）或儿科重症监护医学（PCCM）工作的护理人员、医师和专科培训生。在进行分发之前，开发了一份自我管理的问卷，并对其进行了表面效度评估。邀请符合条件的参与者在 0、2 和 4 周时完成基于网络的调查版本。进行了后续调查管理阶段以提高回复率。
回复率为 72.2%（83/115），其中 83%（68/82）自我识别为护理人员，61%（50/82）为 PCCM 提供者。复苏经验、休克管理频率以及专业年限在 PCCM 和 PEM 应答者之间相似。医生和护士对在休克发作的年轻儿童中实现快速液体复苏的最有效方法有不同的看法（p<0.001）。在应该使用快速输注设备（如 1 级快速输注器）的患者的年龄和体型方面也存在分歧（p<0.001）。提供者对在儿童中使用快速输注器存在一些潜在的关注，只有 14%的医生和 55%的护理人员认为他们已经接受了此类设备使用方面的充分培训（p = 0.005）。
医疗保健提供者在如何实施儿科液体复苏指南方面缺乏共识，这表明需要进一步努力来定义最佳实践。
