From the Department of Anesthesiology and Critical Care, Keck School of Medicine of the University of Southern California, Los Angeles, California.
Department of Anesthesiology, Pain Medicine and Pediatrics, University of Washington, Seattle, Washington.
Anesth Analg. 2018 May;126(5):1580-1587. doi: 10.1213/ANE.0000000000002863.
Few trauma guidelines evaluate and recommend anesthesiology practices and there are no trauma anesthesia-specific guidelines. There is no information on how anesthesiologists perceive clinical practice patterns. Our objective was to understand the perceptions of anesthesiologists regarding trauma anesthesia practices.
A survey assessing anesthesia management of trauma patients was distributed to 21,491 anesthesiologists. A subset of 10 of these questions was subsequently reviewed by a trauma anesthesiology focus group through a 3-round web-based Delphi process. A question was deemed to have respondent consensus if the response with the highest percentage of agreement was unchanged between rounds 1 and 2.
A total of 2360 anesthesiologists (11% response rate) responded to the survey. Results demonstrated that the practitioners' answers conflicted with existing surgical trauma society recommendations (ie, when to transfuse component therapy), and several areas that lacked any guidelines, resulted in response variability among anesthesiologists where not 1 answer achieved >75% agreement (ie, intubation technique of choice for patients with uncleared cervical spine). Thirteen trauma anesthesiologists participated in round 1 (response rate 100%), and 12 responded in rounds 2 and 3 (response rate 92%) of the Delphi process. None of the questions received 100% agreement. Consensus was achieved on 9 of 10 statements pertaining to trauma anesthesia care. Consensus was not reached on the intubating technique in a hemodynamically unstable patient with an uncleared cervical spine with deficits. Delphi participant opinion conflicted with existing guidelines on 2 statements: the use of cricoid pressure, and when to begin blood component therapy.
There are several important areas of trauma anesthesia practice where guidelines do not exist and several where existing guidelines are not endorsed by the majority of practitioners who completed our survey. The lack of consensus on trauma anesthesia management and the variation in survey responses demonstrate a need to develop evidence-based trauma anesthesia guidelines.
很少有创伤指南评估和推荐麻醉科实践，也没有专门针对创伤麻醉的指南。关于麻醉医师如何看待临床实践模式的信息也很少。我们的目的是了解麻醉医师对创伤麻醉实践的看法。
向 21491 名麻醉医师分发了一份评估创伤患者麻醉管理的调查问卷。其中 10 个问题的子集随后通过创伤麻醉学重点小组进行了三轮基于网络的德尔菲法审查。如果第一轮和第二轮之间具有最高百分比一致性的回复没有变化，则认为该问题具有受访者共识。
共有 2360 名麻醉医师（11%的回复率）对调查做出了回应。结果表明，实践人员的回答与现有的外科创伤协会建议相冲突（例如，何时输注成分治疗），并且缺乏任何指南的几个领域导致麻醉医师之间的反应存在差异，没有一个答案获得超过 75%的一致意见（例如，颈椎未明确患者的首选插管技术）。13 名创伤麻醉医师参加了第一轮（回复率为 100%），12 名参加了第二轮和第三轮（回复率为 92%）的德尔菲过程。没有一个问题获得 100%的一致同意。有 9 个关于创伤麻醉护理的陈述达成共识。在颈椎未明确且有缺陷的血流动力学不稳定患者中进行插管的技术以及何时开始血液成分治疗方面没有达成共识。德尔菲参与者的意见与现有的 2 项指南相冲突：使用环状软骨压力和何时开始血液成分治疗。
在创伤麻醉实践中有几个重要领域没有指南，在一些领域，现有的指南也没有得到完成我们调查的大多数从业者的认可。在创伤麻醉管理方面缺乏共识以及调查回复的差异表明需要制定基于证据的创伤麻醉指南。
