Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children's Hospital of Richmond at VCU, Richmond, VA.
Division of Pediatric Critical Care Medicine, Department of Pediatrics, Weill Cornell Medicine, New York, NY.
Pediatr Crit Care Med. 2019 Mar;20(3):e137-e144. doi: 10.1097/PCC.0000000000001828.
Bleeding, a feared complication of critical illness, is frequent in critically ill children. However, the concept of clinically relevant bleeding is ill-defined in this population. There are many established diagnostic criteria for bleeding, but only one estimates bleeding in critically ill adults, and none exist for critically ill children. Our objective was to identify the factors that influence pediatric intensivists' perception of clinically relevant bleeding.
Self-administered, web-based survey with 9-point Likert scales, to qualify the clinical significance of 103 bleeding characteristics in critically ill children.
Online survey.
Pediatric critical care physicians and nurse practitioners.
None.
The response rate was 40%, with 225 respondents from 16 countries. Characteristics most frequently identified as clinically relevant were bleeding in critical locations (e.g., pericardium, pleural space, CNS, and lungs); requiring interventions; leading to physiologic repercussions, including organ failure; and of prolonged duration. Quantifiable bleeding greater than 5 mL/kg/hr for more than 1 hour was frequently considered clinically relevant. Respondents identified the following characteristics as clinically irrelevant: dressings required to be changed no less frequently than every 6 hours, streaks of blood in gastric tubes, streaks of blood in endotracheal tubes or blood in endotracheal tubes only during suctioning, lightly blood-tinged urine, quantifiable bleeding less than 1 mL/kg/hr, and noncoalescing petechiae. Perception of the clinical relevance of bleeding was not associated with the respondent's geographical location of clinical practice or years of experience.
This international survey provides a better understanding of the factors that influence the pediatric intensivists' assessment of the clinical relevance of bleeding in critically ill children. It provides the foundation for the development of a validated, diagnostic definition of clinically relevant bleeding in this population.
出血是危重病患者常见的一种可怕并发症，在危重症儿童中也很常见。然而，在这一人群中，临床相关出血的概念尚未明确。目前有许多已确立的出血诊断标准，但只有一个标准用于估计危重症成人的出血情况，而没有用于危重症儿童的标准。我们的目的是确定影响儿科重症监护医师对临床相关出血的看法的因素。
采用 9 分李克特量表，对 103 种危重症儿童出血特征的临床意义进行自我管理的网络调查。
在线调查。
儿科重症监护医师和护士从业者。
无。
应答率为 40%，来自 16 个国家的 225 名受访者参与了调查。最常被认为具有临床相关性的特征是在关键部位（如心包、胸膜腔、中枢神经系统和肺部）出血；需要干预；导致生理反应，包括器官衰竭；以及持续时间较长。每小时超过 5 毫升/公斤且持续超过 1 小时的可量化出血常被认为具有临床相关性。受访者认为以下特征不具有临床相关性：需要每 6 小时更换一次的敷料、胃管中有血迹、气管内管中有血迹或仅在吸痰时气管内管中有血迹、尿液呈淡血性、每小时少于 1 毫升/公斤的可量化出血和不融合的瘀点。对出血临床相关性的认识与受访者的临床实践地理位置或工作经验年限无关。
这项国际调查更好地了解了影响儿科重症监护医师评估危重症儿童临床相关出血的因素。它为开发针对该人群的临床相关出血的验证性诊断定义奠定了基础。
