Odetola Folafoluwa O, Anspach Renee R, Han Yong Y, Clark Sarah J
Department of Pediatrics and Communicable Diseases, Division of Pediatric Critical Care Medicine, University of Michigan Health System, Ann Arbor, MI; Child Health Evaluation and Research Unit of the Division of General Pediatrics, University of Michigan Health System, Ann Arbor, MI.
Department of Sociology, University of Michigan, Ann Arbor, MI.
J Crit Care. 2017 Feb;37:162-172. doi: 10.1016/j.jcrc.2016.09.022. Epub 2016 Oct 4.
To investigate the decision making underlying transfer of children with respiratory failure from level II to level I pediatric intensive care unit care.
Interviews with 19 eligible level II pediatric intensive care unit physicians about a hypothetical scenario of a 2-year-old girl in respiratory failure: RESULTS: At baseline, indices critical to management were as follows: OI (53%), partial pressure of oxygen in arterial blood (Pao)/Fio (32%), and inflation pressure (16%). Poor clinical response was signified by high OI, inflation pressure, and Fio, and low Pao/Fio. At EP 1, 18 of 19 respondents would initiate high-frequency oscillatory ventilation, and 1 would transfer. At EP 2, 15 of 18 respondents would maintain high-frequency oscillatory ventilation, 9 of them calling to discuss transfer. All respondents would transfer if escalated therapies failed to reverse the patient's clinical deterioration.
Interhospital transfer of children in respiratory failure is triggered by poor response to escalation of locally available care modalities. This finding provides new insight into decision making underlying interhospital transfer of children with respiratory failure.
探讨呼吸衰竭儿童从二级儿科重症监护病房转至一级儿科重症监护病房治疗的决策依据。
就一名2岁呼吸衰竭女童的假设情景对19名符合条件的二级儿科重症监护病房医生进行访谈。
基线时，对治疗至关重要的指标如下：氧合指数（53%）、动脉血氧分压（Pao）/吸入氧分数值（Fio）（32%）和充气压力（16%）。氧合指数、充气压力和Fio值高以及Pao/Fio值低表明临床反应不佳。在事件点1（EP 1），19名受访者中有18人会启动高频振荡通气，1人会选择转院。在事件点2（EP 2），18名受访者中有15人会维持高频振荡通气，其中9人要求讨论转院事宜。如果强化治疗未能扭转患者的临床恶化状况，所有受访者都会选择转院。
呼吸衰竭儿童的院间转院是由对当地现有治疗方式强化治疗反应不佳引发的。这一发现为呼吸衰竭儿童院间转院的决策依据提供了新的见解。
