Pierce Richard, Luckett Peter M, Faustino Edward Vincent S
Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, United States.
Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, United States.
J Pediatr Intensive Care. 2017 Sep;6(3):145-151. doi: 10.1055/s-0036-1593388. Epub 2016 Sep 26.
To determine provider opinions on factors most commonly used to assess the presence and severity of pathologic capillary leak in critically ill children. We conducted an electronic survey of pediatric critical care providers. Patient scenarios were presented to assess opinions on the risk, presence, and clinical significance of capillary leak. Responses were obtained using Likert scales and multiple-choice questions. A total of 160 responses were analyzed. Respondents agreed that capillary leak is present in the scenario with septic shock while respondents somewhat agreed that it is also present with poly-trauma, cardiac arrest, or cardiopulmonary bypass. They agreed that physical exam, but neither agreed nor disagreed that laboratory tests, can be used to assess and follow the severity of capillary leak in these children. Generalized edema, increase in weight, and pulmonary crackles were commonly identified parameters for assessing capillary leak. The patient factor most commonly identified with capillary leak was presence of infection, while treatment factors most commonly identified were cardiopulmonary bypass and general anesthesia. There is agreement that capillary leak is common in critically ill children and exacerbates disease. The parameters identified in this study may facilitate a more standardized clinical evaluation of pathologic capillary leak for future studies.
确定医疗服务提供者对评估危重症儿童病理性毛细血管渗漏的存在及严重程度时最常用因素的看法。我们对儿科重症监护医疗服务提供者进行了一项电子调查。呈现患者病例场景以评估对毛细血管渗漏的风险、存在情况及临床意义的看法。使用李克特量表和多项选择题获取答复。共分析了160份答复。受访者一致认为在脓毒性休克病例场景中存在毛细血管渗漏，而对于多发伤、心脏骤停或体外循环病例场景，受访者 somewhat 同意也存在毛细血管渗漏。他们一致认为体格检查可用于评估和跟踪这些儿童毛细血管渗漏的严重程度，但对于实验室检查，既未表示同意也未表示不同意。全身性水肿、体重增加和肺部啰音是评估毛细血管渗漏时常见的确定参数。与毛细血管渗漏最常相关的患者因素是感染的存在，而最常确定的治疗因素是体外循环和全身麻醉。人们一致认为毛细血管渗漏在危重症儿童中很常见且会加重病情。本研究中确定的参数可能有助于未来研究对病理性毛细血管渗漏进行更标准化的临床评估。
