美国危重病医学会儿童及新生儿感染性休克血流动力学支持临床实践参数

American College of Critical Care Medicine Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Septic Shock.

作者信息

Davis Alan L, Carcillo Joseph A, Aneja Rajesh K, Deymann Andreas J, Lin John C, Nguyen Trung C, Okhuysen-Cawley Regina S, Relvas Monica S, Rozenfeld Ranna A, Skippen Peter W, Stojadinovic Bonnie J, Williams Eric A, Yeh Tim S, Balamuth Fran, Brierley Joe, de Caen Allan R, Cheifetz Ira M, Choong Karen, Conway Edward, Cornell Timothy, Doctor Allan, Dugas Marc-Andre, Feldman Jonathan D, Fitzgerald Julie C, Flori Heidi R, Fortenberry James D, Graciano Ana Lia, Greenwald Bruce M, Hall Mark W, Han Yong Yun, Hernan Lynn J, Irazuzta Jose E, Iselin Elizabeth, van der Jagt Elise W, Jeffries Howard E, Kache Saraswati, Katyal Chhavi, Kissoon Niranjan, Kon Alexander A, Kutko Martha C, MacLaren Graeme, Maul Timothy, Mehta Renuka, Odetola Fola, Parbuoni Kristine, Paul Raina, Peters Mark J, Ranjit Suchitra, Reuter-Rice Karin E, Schnitzler Eduardo J, Scott Halden F, Torres Adalberto, Weingarten-Arams Jacki, Weiss Scott L, Zimmerman Jerry J, Zuckerberg Aaron L

机构信息

1No institution affiliation. 2Department of Critical Care Medicine and Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA. 3Department of Pediatric Critical Care, Riley Hospital for Children, Indiana University, IN. 4Department of Pediatrics, Washington University School of Medicine, St. Louis, MO. 5Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, TX. 6Pediatric Critical Care Medicine, Covenant Women and Children's Hospital, Texas Tech University, Lubbock, TX. 7Division of Pediatric Critical Care Medicine, Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL. 8Division of Pediatric Critical Care, University of British Columbia, Vancouver, BC, Canada. 9Division of Pediatric Critical Care Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI. 10Department of Pediatrics, Baylor College of Medicine, Houston, TX. 11Department of Pediatrics, Saint Barnabas Medical Center, Livingston, NJ. 12Division of Emergency Medicine and Center for Pediatric Clinical Effectiveness, University of Pennsylvania Perelman School of Medicine, Children's Hospital of Philadelphia, Philadelphia, PA. 13Intensive Care & Bioethics, Great Ormond St Hospital for Sick Children, London, United Kingdom. 14Pediatric Critical Care Medicine, Department of Pediatrics, Stollery Children's Hospital/University of Alberta, Edmonton, AB, Canada. 15Division of Pediatric Critical Care Medicine, Department of Pediatrics, Duke Children's, Durham, NC. 16Departments of Pediatrics and Critical Care, Clinical Epidemiology and Biostatistics, McMaster University, Pediatric Intensive Care Unit, McMaster Children's Hospital, Hamilton, ON, Canada. 17Beth Israel Medical Center, Hartsdale, NY. 18Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI. 19Departments of Pediatrics and Biochemistry, Washington University in Saint Louis School of Medicine, Saint Louis, MO. 20Department of Pediatrics, Centre mère-enfant Soleil du CHU de Québec-Université Laval, Québec City, QC, Canada. 21Department of Inpatient Pediatrics, Kaiser Santa Clara Medical Center, Santa Clara, CA. 22Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania Perelman School of Medicine, Children's Hospital of Philadelphia, Philadelphia, PA. 23Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Mott C.S. Children's Hospital, Ann Arbor, MI. 24Division of Critical Care, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA. 25Department of Pediatrics-Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD. 26Division of Pediatric Critical Care Medicine, Weill Cornell Medical College, New York, NY. 27Division of Critical Care Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH. 28Department of Critical Care Medicine, Children's Mercy Hospital, Kansas City, MO. 29Department of Pediatrics, Texas Tech University Health Sciences Center, El Paso, TX. 30Division of Pediatric Critical Care, University of Florida, Jacksonville, FL. 31Bon Secours St. Mary's Hospital, Glen Allen, VA. 32Division of Pediatric Critical Care, Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, NY. 33Department of Pediatrics, University of Washington School of Medicine, Seattle, WA. 34Division of Critical Care, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA. 35Pediatric Critical Care Medicine, The Children's Hospital at Montefiore, The Pediatric Hospital for Albert Einstein College of Medicine, Bronx, NY. 36Department of Pediatrics, University of British Columbia, UBC & BC Children's Hospital Professor in Critical Care-Global Child Health, Vancouver, BC, Canada. 37Department of Pediatrics, Naval Medical Center San Diego and University of California San Diego School of Medicine, San Diego, CA. 38Department of Pediatrics and Pediatric Critical Care Medicine, The Valley Hospital, Ridgewood, NJ. 39Cardiothoracic ICU, National University Hospital, Singapore. 40Paediatric ICU, The Royal Children's Hospital, Melbourne, Australia. 41Department of Paediatrics, University of Melbourne, Melbourne, Australia. 42Children's Hospital of Pittsburgh, Pittsburgh, PA. 43Department of Pediatrics, Medical College of Georgia at Augusta University, Augusta, GA. 44Division of Critical Care Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, MI. 45Department of Pharmacy Practice, Loma Linda University School of Pharmacy, Loma Linda, CA. 46Division of Emergency Medicine, Ann and Robert Lurie Children's Hospital of Chicago, Feinberg School of Medicine at Northwestern University, Chicago, IL. 47UCL Great Ormond Street Institute of Child Health and Paediatric Intensive Care Unit, Great Ormond Street Hospital for Children, NHS Trust, London, United Kingdom. 48Pediatric Intensive Care and Emergency Services, Apollo Children's Hospital, Chennai, India. 49Division of Pediatric Critical Care, Department of Pediatrics, Duke University School of Nursing and School of Medicine, Durham, NC. 50Pediatrics School of Medicine, Austral University, Pcia de Buenos Aires, Argentina. 51Departments of Pediatrics and Emergency Medicine, University of Colorado School of Medicine, Aurora, CO. 52Critical Care and Transport, Nemours Children's Hospital, Orlando, FL. 53Department of Pediatrics, Critical Care Medicine, Albert Einstein College of Medicine, Bronx, NY. 54Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA. 55Departments of Pediatrics & Anesthesiology, Sinai Hospital/NAPA, Baltimore, MD. 56Department of Pediatrics, University of Maryland Medical School, Baltimore, MD.

出版信息

Crit Care Med. 2017 Jun;45(6):1061-1093. doi: 10.1097/CCM.0000000000002425.

DOI:10.1097/CCM.0000000000002425

PMID:28509730

Abstract

OBJECTIVES

The American College of Critical Care Medicine provided 2002 and 2007 guidelines for hemodynamic support of newborn and pediatric septic shock. Provide the 2014 update of the 2007 American College of Critical Care Medicine "Clinical Guidelines for Hemodynamic Support of Neonates and Children with Septic Shock."

DESIGN

Society of Critical Care Medicine members were identified from general solicitation at Society of Critical Care Medicine Educational and Scientific Symposia (2006-2014). The PubMed/Medline/Embase literature (2006-14) was searched by the Society of Critical Care Medicine librarian using the keywords: sepsis, septicemia, septic shock, endotoxemia, persistent pulmonary hypertension, nitric oxide, extracorporeal membrane oxygenation, and American College of Critical Care Medicine guidelines in the newborn and pediatric age groups.

MEASUREMENTS AND MAIN RESULTS

The 2002 and 2007 guidelines were widely disseminated, translated into Spanish and Portuguese, and incorporated into Society of Critical Care Medicine and American Heart Association/Pediatric Advanced Life Support sanctioned recommendations. The review of new literature highlights two tertiary pediatric centers that implemented quality improvement initiatives to improve early septic shock recognition and first-hour compliance to these guidelines. Improved compliance reduced hospital mortality from 4% to 2%. Analysis of Global Sepsis Initiative data in resource rich developed and developing nations further showed improved hospital mortality with compliance to first-hour and stabilization guideline recommendations.

CONCLUSIONS

The major new recommendation in the 2014 update is consideration of institution-specific use of 1) a "recognition bundle" containing a trigger tool for rapid identification of patients with septic shock, 2) a "resuscitation and stabilization bundle" to help adherence to best practice principles, and 3) a "performance bundle" to identify and overcome perceived barriers to the pursuit of best practice principles.

摘要

目标

美国危重病医学会分别于2002年和2007年发布了新生儿和儿童感染性休克血流动力学支持指南。现提供2014年对2007年美国危重病医学会《新生儿和儿童感染性休克血流动力学支持临床指南》的更新内容。

设计

通过在危重病医学会教育与科学研讨会（2006 - 2014年）上广泛征集，确定危重病医学会成员。危重病医学会的图书馆员使用关键词“脓毒症、败血症、感染性休克、内毒素血症、持续性肺动脉高压、一氧化氮、体外膜肺氧合以及新生儿和儿童年龄组的美国危重病医学会指南”检索了PubMed/Medline/Embase文献（2006 - 2014年）。

测量与主要结果

2002年和2007年的指南得到广泛传播，被翻译成西班牙语和葡萄牙语，并纳入危重病医学会以及美国心脏协会/儿科高级生命支持认可的建议中。对新文献的综述突出了两个三级儿科中心实施的质量改进举措，以提高对早期感染性休克的识别以及对这些指南首小时的依从性。依从性的提高使医院死亡率从4%降至2%。对资源丰富的发达国家和发展中国家全球脓毒症倡议数据的分析进一步表明，遵循首小时和稳定指南建议可改善医院死亡率。