Kanthimathinathan Hari Krishnan, Scholefield Barnaby R
Paediatric Intensive Care Unit, Evelina London Children's Hospital, London, UK.
Paediatric Intensive Care Unit, Birmingham Children's Hospital, Birmingham, UK.
Arch Dis Child. 2014 Nov;99(11):1043-9. doi: 10.1136/archdischild-2013-304871. Epub 2014 Jun 11.
Providing evidence-based interventions for infants and children is important in paediatric intensive care, where decision making impacts most acutely on morbidity and mortality. However, despite the major progress of medicine in the 21st century, we still lack this evidence for majority of the decisions we make. In this article, we explore and suggest possible solutions for several dilemmas faced by paediatric intensive care researchers. These include ethical dilemmas such as validity of informed consent, use of deferred consent, balancing risk versus benefit and methodological dilemmas such as how to generate high-quality evidence with low-patient volume, choice of valid outcome measures and how best to use research and researchers' networks.
在儿科重症监护中，为婴幼儿提供循证干预措施非常重要，因为在此环境下，决策对发病率和死亡率的影响最为直接。然而，尽管21世纪医学取得了重大进展，但对于我们所做的大多数决策，我们仍然缺乏相关证据。在本文中，我们探讨并提出了儿科重症监护研究人员面临的几个困境的可能解决方案。这些困境包括伦理困境，如知情同意的有效性、延期同意的使用、风险与益处的权衡，以及方法学困境，如如何在低患者数量的情况下产生高质量证据、有效结局指标的选择，以及如何最好地利用研究和研究人员网络。
