Ake N. Grenvik Professor of Critical Care Medicine, Vice Chair, Department of Critical Care Medicine, Professor of Anesthesiology, Pediatrics, Bioengineering, and Clinical and Translational Science, Director, Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA.
Department of Neurology and Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA.
Pediatr Crit Care Med. 2019 Mar;20(3):280-289. doi: 10.1097/PCC.0000000000001736.
The purpose of this work is to identify and synthesize research produced since the second edition of these Guidelines was published and incorporate new results into revised evidence-based recommendations for the treatment of severe traumatic brain injury in pediatric patients.
This document provides an overview of our process, lists the new research added, and includes the revised recommendations. Recommendations are only provided when there is supporting evidence. This update includes 22 recommendations, nine are new or revised from previous editions. New recommendations on neuroimaging, hyperosmolar therapy, analgesics and sedatives, seizure prophylaxis, temperature control/hypothermia, and nutrition are provided. None are level I, three are level II, and 19 are level III. The Clinical Investigators responsible for these Guidelines also created a companion algorithm that supplements the recommendations with expert consensus where evidence is not available and organizes possible interventions into first and second tier utilization. The purpose of publishing the algorithm as a separate document is to provide guidance for clinicians while maintaining a clear distinction between what is evidence based and what is consensus based. This approach allows, and is intended to encourage, continued creativity in treatment and research where evidence is lacking. Additionally, it allows for the use of the evidence-based recommendations as the foundation for other pathways, protocols, or algorithms specific to different organizations or environments. The complete guideline document and supplemental appendices are available electronically from this journal. These documents contain summaries and evaluations of all the studies considered, including those from prior editions, and more detailed information on our methodology.
New level II and level III evidence-based recommendations and an algorithm provide additional guidance for the development of local protocols to treat pediatric patients with severe traumatic brain injury. Our intention is to identify and institute a sustainable process to update these Guidelines as new evidence becomes available.
本研究旨在对第二版指南发布后产生的研究进行识别和综合，并将新的研究结果纳入修订后的儿童严重创伤性脑损伤治疗循证推荐意见。
本文概述了我们的工作流程，列出了新增的研究，并包含了修订后的推荐意见。只有在有证据支持的情况下才提供推荐意见。本更新包括 22 项推荐意见，其中 9 项是来自前几版的新推荐或修订推荐。新增了神经影像学、高渗治疗、镇痛药和镇静剂、癫痫预防、体温控制/低温和营养方面的推荐意见。没有一级推荐，有 3 项二级推荐，19 项三级推荐。负责这些指南的临床调查员还创建了一个配套算法，在没有证据的情况下，用专家共识补充推荐意见，并将可能的干预措施组织成第一和第二优先级使用。将算法作为单独的文件发布的目的是为临床医生提供指导，同时明确区分基于证据和基于共识的内容。这种方法允许并旨在鼓励在缺乏证据的情况下继续在治疗和研究方面进行创新。此外，它还允许将循证推荐意见作为其他途径、方案或特定于不同组织或环境的特定算法的基础。完整的指南文件和补充附录可从本刊获得电子版本。这些文件包含了所有考虑中的研究的摘要和评估，包括前几版的研究，以及关于我们方法学的更详细信息。
新的二级和三级循证推荐意见和算法为制定治疗儿童严重创伤性脑损伤的局部方案提供了额外的指导。我们的意图是确定并建立一个可持续的流程，以便在新证据出现时更新这些指南。
