一项关于使用皮质类固醇治疗低心排血量综合征的国际调查。
An International Survey of Corticosteroid Use for the Management of Low Cardiac Output Syndrome.
作者信息
Flores Saul, FitzGerald Michael R, Iliopoulos Ilias, Daily Joshua A, Rodriguez Marco, Nelson David P, Wong Hector R, Menon Kusum, Cooper David S
机构信息
1Section of Critical Care Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, TX. 2Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH. 3Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH. 4The Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH. 5Division of Cardiology, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, AR. 6Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH. 7Division of Pediatric Critical Care, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada.
出版信息
Pediatr Crit Care Med. 2017 Jul;18(7):630-637. doi: 10.1097/PCC.0000000000001180.
OBJECTIVE
Limited evidence exists on use of corticosteroids in low cardiac output syndrome following cardiac surgery. We sought to determine physicians' practices and beliefs with regard to corticosteroids therapy for low cardiac output syndrome.
DESIGN
Multinational internet-based survey.
SETTING
Pediatric Cardiac Intensive Care Society member database.
SUBJECTS
Pediatric cardiac intensive care physicians.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
We received 188 responses from 85 centers throughout the world including 57 U.S. congenital heart centers, eight Canadian centers, and 20 international centers. The majority of respondents (51%) reported performing at least 200 bypass cases per year and had separate dedicated cardiac ICUs (57%). Most physicians (89%) rarely or never prescribe corticosteroids for mild low cardiac output syndrome (single vasoactive agent and mildly decreased perfusion), whereas 94% of those surveyed sometimes or always administer corticosteroids to patients with severe low cardiac output syndrome (two or more vasoactive agents and persistent hypotension). Hydrocortisone was the most commonly used corticosteroids (88%), but there was no consensus on dosage used. There was a variable approach to cortisol level measurement and cortisol stimulation testing to inform therapy with corticosteroids. A majority of respondents (75%) stated that they would be willing to randomize patients with severe low cardiac output syndrome into a trial of corticosteroids efficacy.
CONCLUSIONS
Our survey demonstrates considerable practice variability with regard to the type of patients in whom corticosteroids are administered, adrenal axis testing is performed, and dosage of hydrocortisone used. The majority of physicians, however, stated their willingness to randomize patients with severe low cardiac output syndrome in a corticosteroids trial. This survey identified multiple areas for future research on use of corticosteroids for low cardiac output syndrome.
目的
关于心脏手术后低心排血量综合征使用皮质类固醇的证据有限。我们试图确定医生在低心排血量综合征皮质类固醇治疗方面的实践和看法。
设计
基于互联网的多国调查。
背景
儿科心脏重症监护学会成员数据库。
研究对象
儿科心脏重症监护医生。
干预措施
无。
测量指标及主要结果
我们收到了来自全球85个中心的188份回复，其中包括57个美国先天性心脏病中心、8个加拿大中心和20个国际中心。大多数受访者（51%）报告每年至少进行200例搭桥手术，且设有独立的心脏重症监护病房（57%）。大多数医生（89%）很少或从不为轻度低心排血量综合征（单一血管活性药物且灌注轻度降低）开具皮质类固醇，而94%的受访者有时或总是为重度低心排血量综合征（两种或更多血管活性药物且持续低血压）患者使用皮质类固醇。氢化可的松是最常用的皮质类固醇（88%），但在使用剂量上没有共识。在通过测量皮质醇水平和进行皮质醇刺激试验来指导皮质类固醇治疗方面，方法各异。大多数受访者（75%）表示愿意将重度低心排血量综合征患者随机纳入皮质类固醇疗效试验。
结论
我们的调查表明，在使用皮质类固醇的患者类型、进行肾上腺轴检测以及氢化可的松的使用剂量方面，实践存在很大差异。然而，大多数医生表示愿意将重度低心排血量综合征患者随机纳入皮质类固醇试验。这项调查确定了未来关于低心排血量综合征使用皮质类固醇研究的多个领域。
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