1University of Utah College of Nursing, Salt Lake City, UT. 2Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, UT. 3Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA. 4Department of Pediatrics, University of Southern California, Keck School of Medicine, Los Angeles, CA. 5Division of Pediatric Critical Care, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT. 6Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI. 7Department of Critical Care Medicine, Children's Hospital of Pittsburgh, Pittsburgh, PA. 8Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL. 9Department of Pediatrics, University of Michigan, Ann Arbor, MI. 10Department of Pediatrics, Children's National Medical Center, Washington, DC. 11Department of Child Health, Phoenix Children's Hospital, Phoenix, AZ. 12Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA. 13Department of Pediatrics, Mattel Children's Hospital UCLA, Los Angeles, CA. 14Departments of Pediatrics and Biochemistry, Washington University School of Medicine, St. Louis, MO. 15Pediatric Trauma and Critical Injury Branch, Eunice Kennedy Shriver National Institutes of Child Health and Human Development (NICHD), National Institutes of Health, Bethesda, MD. 16Formerly Pediatric Trauma and Critical Injury Branch, Eunice Kennedy Shriver National Institutes of Child Health and Human Development (NICHD), National Institutes of Health, Bethesda, MD.
Pediatr Crit Care Med. 2017 Nov;18(11):1027-1034. doi: 10.1097/PCC.0000000000001331.
To examine issues regarding the granularity (size/scale) and potential acceptability of recommendations in a ventilator management protocol for children with pediatric acute respiratory distress syndrome.
Survey/questionnaire.
The eight PICUs in the Collaborative Pediatric Critical Care Research Network.
One hundred twenty-two physicians (attendings and fellows).
None.
We used an online questionnaire to examine attitudes and assessed recommendations with 50 clinical scenarios. Overall 80% of scenario recommendations were accepted. Acceptance did not vary by provider characteristics but did vary by ventilator mode (high-frequency oscillatory ventilation 83%, pressure-regulated volume control 82%, pressure control 75%; p = 0.002) and variable adjusted (ranging from 88% for peak inspiratory pressure and 86% for FIO2 changes to 69% for positive end-expiratory pressure changes). Acceptance did not vary based on child size/age. There was a preference for smaller positive end-expiratory pressure changes but no clear granularity preference for other variables.
Although overall acceptance rate for scenarios was good, there was little consensus regarding the size/scale of ventilator setting changes for children with pediatric acute respiratory distress syndrome. An acceptable protocol could support robust evaluation of ventilator management strategies. Further studies are needed to determine if adherence to an explicit protocol leads to better outcomes.
研究儿童急性呼吸窘迫综合征呼吸机管理方案中推荐意见的粒度（大小/规模）和潜在可接受性问题。
调查/问卷调查。
合作儿科危重病研究网络的 8 个 PICUs。
122 名医生（主治医生和研究员）。
无。
我们使用在线问卷来检查态度，并使用 50 个临床场景评估推荐意见。总体而言，80%的方案推荐意见被接受。接受度不受提供者特征的影响，但因呼吸机模式而异（高频振荡通气 83%，压力调节容量控制 82%，压力控制 75%；p=0.002）和变量调整（从峰压的 88%和 FiO2 变化的 86%到呼气末正压变化的 69%不等）。接受度与儿童的体型/年龄无关。人们更喜欢较小的呼气末正压变化，但对其他变量的粒度没有明显偏好。
尽管对方案的总体接受率较高，但对于儿童急性呼吸窘迫综合征患者的呼吸机设置变化大小/规模，共识很少。一个可接受的方案可以支持对呼吸机管理策略的有力评估。需要进一步的研究来确定是否遵循明确的方案会导致更好的结果。
