Valentine Stacey L, Nadkarni Vinay M, Curley Martha A Q
1Department of Pediatrics, Division of Pediatric Critical Care, University of Massachusetts Children's Medical Center, Worcester, MA. 2Department of Anesthesiology, Perioperative and Pain Medicine, Critical Care Division, Boston Children's Hospital, Boston, MA. 3Department of Anesthesia, Critical Care and Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. 4Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA. 5Department of Anesthesia and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. 6Department of Cardiovascular and Critical Care Services, Boston Children's Hospital, Boston, MA.
Pediatr Crit Care Med. 2015 Jun;16(5 Suppl 1):S73-85. doi: 10.1097/PCC.0000000000000435.
To describe the recommendations from the Pediatric Acute Lung Injury Consensus Conference on nonpulmonary treatments in pediatric acute respiratory distress syndrome.
Consensus conference of experts in pediatric acute lung injury.
A panel of 27 experts met over the course of 2 years to develop a taxonomy to define pediatric acute respiratory distress syndrome and to make recommendations regarding treatment and research priorities. The nonpulmonary subgroup comprised three experts. When published data were lacking, a modified Delphi approach emphasizing strong professional agreement was utilized.
The Pediatric Acute Lung Injury Consensus Conference experts developed and voted on a total of 151 recommendations addressing the topics related to pediatric acute respiratory distress syndrome, 30 of which related to nonpulmonary treatment. All 30 recommendations had strong agreement. Patients with pediatric acute respiratory distress syndrome should receive 1) minimal yet effective targeted sedation to facilitate mechanical ventilation; 2) neuromuscular blockade, if sedation alone is inadequate to achieve effective mechanical ventilation; 3) a nutrition plan to facilitate their recovery, maintain their growth, and meet their metabolic needs; 4) goal-directed fluid management to maintain adequate intravascular volume, end-organ perfusion, and optimal delivery of oxygen; and 5) goal-directed RBC transfusion to maintain adequate oxygen delivery. Future clinical trials in pediatric acute respiratory distress syndrome should report sedation, neuromuscular blockade, nutrition, fluid management, and transfusion exposures to allow comparison across studies.
The Consensus Conference developed pediatric-specific definitions for pediatric acute respiratory distress syndrome and recommendations regarding treatment and future research priorities. These recommendations for nonpulmonary treatment in pediatric acute respiratory distress syndrome are intended to promote optimization and consistency of care for patients with pediatric acute respiratory distress syndrome and identify areas of uncertainty requiring further investigation.
描述儿科急性肺损伤共识会议关于小儿急性呼吸窘迫综合征非肺部治疗的建议。
儿科急性肺损伤专家共识会议。
一个由27名专家组成的小组在2年时间里会面，制定了一个分类法来定义小儿急性呼吸窘迫综合征，并就治疗和研究重点提出建议。非肺部亚组由三名专家组成。当缺乏已发表的数据时，采用强调强烈专业共识的改良德尔菲法。
儿科急性肺损伤共识会议专家制定并投票通过了总共151条关于小儿急性呼吸窘迫综合征相关主题的建议，其中30条与非肺部治疗有关。所有30条建议都获得了强烈共识。小儿急性呼吸窘迫综合征患者应接受以下治疗：1）最小有效剂量的靶向镇静以利于机械通气；2）如果仅靠镇静不足以实现有效的机械通气，则使用神经肌肉阻滞剂；3）制定营养计划以促进康复、维持生长并满足代谢需求；4）目标导向的液体管理以维持足够的血管内容量、终末器官灌注和最佳的氧气输送；5）目标导向的红细胞输注以维持足够的氧气输送。未来关于小儿急性呼吸窘迫综合征的临床试验应报告镇静、神经肌肉阻滞剂、营养、液体管理和输血情况，以便进行研究间的比较。
共识会议制定了小儿急性呼吸窘迫综合征的儿科特定定义以及关于治疗和未来研究重点的建议。这些关于小儿急性呼吸窘迫综合征非肺部治疗的建议旨在促进对小儿急性呼吸窘迫综合征患者护理的优化和一致性，并确定需要进一步研究的不确定领域。
