肯尼亚针对严重脱水儿童的透明质酸酶辅助复苏治疗

Hyaluronidase-Assisted Resuscitation in Kenya for Severely Dehydrated Children.

作者信息

Zubairi Hijab, Nelson Brett D, Tulshian Priyanka, Fredricks Karla, Altawil Zaid, Mireles Sarah, Odongo Fred, Burke Thomas F

机构信息

From the Division of Global Health and Human Rights, Department of Emergency Medicine, Massachusetts General Hospital.

African Institute of Health Transformation, Sagam Community Hospital, Sagam, Kenya.

出版信息

Pediatr Emerg Care. 2019 Oct;35(10):692-695. doi: 10.1097/PEC.0000000000001183.

DOI:10.1097/PEC.0000000000001183

PMID:28678057

Abstract

BACKGROUND

Dehydration, mainly due to diarrheal illnesses, is a leading cause of childhood mortality worldwide. Intravenous (IV) therapy is the standard of care for patients who were unable to tolerate oral rehydration; however, placing IVs in fragile, dehydrated veins can be challenging. Studies in resource-rich settings comparing hyaluronidase-assisted subcutaneous rehydration with standard IV rehydration in children have demonstrated several benefits of subcutaneous rehydration, including time and success of line placement, ease of use, satisfaction, and cost-effectiveness.

METHODS

A single-arm trial assessing the feasibility of hyaluronidase-assisted subcutaneous resuscitation for the treatment of moderately to severely dehydrated individuals in western Kenya was conducted. Children aged 2 months or older who presented with moderately to severely dehydration clinically warranting parenteral rehydration and had at least 2 failed IV attempts were eligible. Study staff received training on standard dehydration management and hyaluronidase infusion processes. Children received all other standards of care. They were monitored from presentation and through discharge, with a 1-week phone follow-up. Predischarge surveys were completed by caregivers, and semistructured interviews with providers were performed.

RESULTS

A total of 51 children were enrolled (median age, 13.0 months; interquartile range of 18 months). Fifty-one patients (100%) had severe dehydration. The median length of subcutaneous infusion was 3.0 hours (interquartile range [IQR], 2.95). The median total subcutaneous infusion was 700.0 mL (IQR, 420 mL). Median time to resolution of moderate to severe dehydration symptoms was 3.0 hours (IQR, 2.95 hours). There were no significant complications.

CONCLUSIONS

Hyaluronidase-assisted subcutaneous resuscitation is a feasible alternative to IV hydration in moderately to severely dehydrated children with difficult to obtain IV access in resource-limited areas.

摘要

背景

脱水主要由腹泻疾病引起，是全球儿童死亡的主要原因。静脉输液治疗是无法耐受口服补液患者的标准治疗方法；然而，在脆弱、脱水的静脉中放置静脉导管可能具有挑战性。在资源丰富环境中进行的研究比较了透明质酸酶辅助皮下补液与儿童标准静脉补液，结果显示皮下补液有诸多益处，包括置管时间和成功率、易用性、满意度以及成本效益。

方法

开展了一项单臂试验，评估透明质酸酶辅助皮下复苏治疗肯尼亚西部中度至重度脱水个体的可行性。年龄在2个月及以上、临床诊断为中度至重度脱水且需要肠外补液、至少2次静脉穿刺失败的儿童符合入选标准。研究人员接受了标准脱水管理和透明质酸酶输注流程的培训。儿童接受所有其他标准护理。从就诊到出院对他们进行监测，并进行为期1周的电话随访。由照料者完成出院前调查，并对提供者进行半结构化访谈。

结果

共纳入51名儿童（中位年龄13.0个月；四分位间距为18个月）。51例患者（100%）为重度脱水。皮下输注的中位时长为3.0小时（四分位间距[IQR]，2.95）。皮下输注总量的中位数为700.0 mL（IQR，420 mL）。中度至重度脱水症状缓解的中位时间为3.0小时（IQR，2.95小时）。无显著并发症。