加拿大循环判定死亡后小儿器官捐献指南-概要报告。
Canadian Guidelines for Controlled Pediatric Donation After Circulatory Determination of Death-Summary Report.
机构信息
1Division of Pediatric Intensive Care, CHU de Quebec, Centre Mère-Enfant Soleil, Québec, QC, Canada.2Department of Pediatrics, Université Laval Faculté de Médecine, Québec, QC, Canada.3Canadian Blood Services Decreased Donation, Ottawa, ON, Canada.4Department of Medicine & Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, ON, Canada.5Division of Neonatal Intensive Care, University of Alberta & Stollery Children's Hospitals, Edmonton, AB, Canada.6Division of Critical Care, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.7Division of Paediatric Cardiac Intensive Care Unit, University of Alberta & Stollery Children's Hospitals, Edmonton, AB, Canada.8Division of Critical Care, BC Children's Hospital, Vancouver, BC, Canada.9Bioethics Program, University Health Network, Toronto, ON, Canada.10Critical Care Medicine, Département de pédiatrie, CHU Sainte-Justine, Montréal, QC, Canada.11Department of Pediatrics and Child Health, Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada.12Department of Bioethics, Hospital for Sick Children, Toronto, ON, Canada.13Division of Paediatric Critical Care Medicine, Western University Children's Hospital, London, ON, Canada.14Division of Critical Care, Johns Hopkins All Children's Hospital, St. Petersburg, FL.15Information Specialist, Québec, QC, Canada.16Division of Pediatric Intensive Care, Janeway Childrens Health and Rehabilitation Centre, St. Johns, NL, Canada.17Division of Pediatric Intensive Care, Victoria General Hospital, Victoria, BC, Canada.18Division of Neonatal Intensive Care, Children's Hospital of the London Health Sciences Centre, London, ON, Canada.19Division of Pediatric Intensive Care, University of Alberta & Stollery Children's Hospitals, Edmonton, AB, Canada.20Division of Pediatric Critical Care, Hamilton Health Sciences, Hamilton, ON, Canada.21Canadian Blood Services Legal Department, Ottawa, ON, Canada.22Division of Pediatric Cardiology, Hospital for Sick Children, Toronto, ON, Canada.23Division of Cardiac Surgery, University of Alberta Hospital, Edmonton, AB, Canada.24Division of Nephrology, Hospital for Sick Children, Toronto, ON, Canada.25Division of Pediatric Anesthesia, Stollery Children's Hospital, Edmonton, AB, Canada.26Division of Pediatric Intensive Care, Alberta Children's Hospital, Calgary, AB, Canada.27Division of Neonatal Intensive Care, BC Women's Hospital + Health Centre, Vancouver, BC, Canada.28Division of Neonatology, Hospital for Sick Children, Toronto, ON, Canada.29Division of Critical Care, Montreal Children's Hospital, McGill University Health Centre and Research Institute, Montréal, QC, Canada.30Division of Critical Care, Montreal Children's Hospital, McGill University Health Centre and Research Institute, Montréal, QC, Canada.31Department of Pediatrics, McGill University, Montréal, QC, Canada.
出版信息
Pediatr Crit Care Med. 2017 Nov;18(11):1035-1046. doi: 10.1097/PCC.0000000000001320.
OBJECTIVES
Create trustworthy, rigorous, national clinical practice guidelines for the practice of pediatric donation after circulatory determination of death in Canada.
METHODS
We followed a process of clinical practice guideline development based on World Health Organization and Canadian Medical Association methods. This included application of Grading of Recommendations Assessment, Development, and Evaluation methodology. Questions requiring recommendations were generated based on 1) 2006 Canadian donation after circulatory determination of death guidelines (not pediatric specific), 2) a multidisciplinary symposium of national and international pediatric donation after circulatory determination of death leaders, and 3) a scoping review of the pediatric donation after circulatory determination of death literature. Input from these sources drove drafting of actionable questions and Good Practice Statements, as defined by the Grading of Recommendations Assessment, Development, and Evaluation group. We performed additional literature reviews for all actionable questions. Evidence was assessed for quality using Grading of Recommendations Assessment, Development, and Evaluation and then formulated into evidence profiles that informed recommendations through the evidence-to-decision framework. Recommendations were revised through consensus among members of seven topic-specific working groups and finalized during meetings of working group leads and the planning committee. External review was provided by pediatric, critical care, and critical care nursing professional societies and patient partners.
RESULTS
We generated 63 Good Practice Statements and seven Grading of Recommendations Assessment, Development, and Evaluation recommendations covering 1) ethics, consent, and withdrawal of life-sustaining therapy, 2) eligibility, 3) withdrawal of life-sustaining therapy practices, 4) ante and postmortem interventions, 5) death determination, 6) neonatal pediatric donation after circulatory determination of death, 7) cardiac and innovative pediatric donation after circulatory determination of death, and 8) implementation. For brevity, 48 Good Practice Statement and truncated justification are included in this summary report. The remaining recommendations, detailed methodology, full Grading of Recommendations Assessment, Development, and Evaluation tables, and expanded justifications are available in the full text report.
CONCLUSIONS
This process showed that rigorous, transparent clinical practice guideline development is possible in the domain of pediatric deceased donation. Application of these recommendations will increase access to pediatric donation after circulatory determination of death across Canada and may serve as a model for future clinical practice guideline development in deceased donation.
目的
为加拿大循环死亡后儿科捐献制定值得信赖、严谨的国家临床实践指南。
方法
我们遵循世界卫生组织和加拿大医师协会方法的临床实践指南制定流程。这包括应用推荐评估、制定和评估方法学。需要推荐的问题是基于 1）2006 年加拿大循环死亡后捐献指南（非儿科特定），2）国家和国际循环死亡后儿科捐献多学科研讨会的领导，以及 3）循环死亡后儿科捐献文献的范围审查。这些来源的投入推动了可操作问题和良好实践声明的起草，这些问题和声明由推荐评估、制定和评估小组定义。我们对所有可操作问题进行了额外的文献综述。使用推荐评估、制定和评估评估证据质量，然后将其纳入证据决策框架，为建议提供信息的证据概况。建议通过七个专题工作组的成员之间的共识进行修订，并在工作组负责人和计划委员会的会议上最终确定。外部审查由儿科、重症监护和重症监护护理专业协会以及患者伙伴提供。
结果
我们生成了 63 条良好实践声明和 7 条推荐评估、制定和评估建议，涵盖 1）伦理、同意和停止生命支持治疗，2）资格，3）停止生命支持治疗实践，4）前后干预，5）死亡确定，6）新生儿循环死亡后儿科捐献，7）心脏和创新儿科循环死亡后捐献，以及 8）实施。为了简洁起见，本总结报告中包含了 48 条良好实践声明和简化的理由。其余建议、详细方法、完整的推荐评估、制定和评估表以及扩展的理由可在全文报告中获得。
结论
该过程表明，在儿科死亡捐献领域，严格、透明的临床实践指南制定是可行的。这些建议的应用将增加加拿大各地儿科循环死亡后捐献的机会，并可能成为未来死亡捐献临床实践指南制定的模型。
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