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小儿院外心脏骤停后治疗性低温治疗的实践模式:一项针对儿科重症监护医师的调查

Practice Patterns after the Therapeutic Hypothermia After Pediatric Cardiac Arrest Out-of-Hospital Trial: A Survey of Pediatric Critical Care Physicians.

作者信息

Gildea Marianne R, Moler Frank W, Page Kent, Pemberton Victoria L, Holubkov Richard, Nadkarni Vinay M, Dean J Michael, Olson Lenora M

机构信息

Department of Pediatrics, University of Utah, Salt Lake City, Utah, United States.

Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan, United States.

出版信息

J Pediatr Intensive Care. 2019 Jun;8(2):71-77. doi: 10.1055/s-0038-1667380. Epub 2018 Aug 12.

Abstract

The Therapeutic Hypothermia After Pediatric Cardiac Arrest Out-of-Hospital (THAPCA-OH) Trial showed therapeutic hypothermia, versus normothermia, did not significantly improve 1-year survival with good neurobehavioral outcome. Our survey of pediatric critical care physicians, designed to assess the use of targeted temperature management (TTM) after publication of the main THAPCA-OH Trial results, found most respondents were aware of trial results, and over 90% agreed THAPCA-OH was well-designed with important clinical outcomes. While most respondents reported TTM usage consistent with THAPCA-OH results in different patient scenarios, 15% did not select TTM for fever management. Since trials prior to THAPCA-OH established that fever is harmful following brain injury, the continued incomplete adoption of TTM warrants further research on challenges and facilitators to the adoption of clinical trial findings.

摘要

院外小儿心脏骤停后治疗性低温(THAPCA - OH)试验表明,与正常体温相比,治疗性低温并不能显著提高1年生存率及良好的神经行为学转归。我们针对儿科重症监护医生开展的一项调查旨在评估在THAPCA - OH试验主要结果发表后目标温度管理(TTM)的使用情况,结果发现大多数受访者知晓试验结果,且超过90%的受访者认为THAPCA - OH设计良好且具有重要的临床结局。虽然大多数受访者报告称在不同患者情况下TTM的使用与THAPCA - OH结果一致,但15%的受访者未选择TTM用于发热管理。由于THAPCA - OH之前的试验已证实脑损伤后发热有害,TTM的持续未完全采用值得进一步研究采用临床试验结果所面临的挑战和促进因素。

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本文引用的文献

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Therapeutic hypothermia after out-of-hospital cardiac arrest in children.儿童院外心脏骤停后的治疗性低温
N Engl J Med. 2015 May 14;372(20):1898-908. doi: 10.1056/NEJMoa1411480. Epub 2015 Apr 25.
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Targeted temperature management at 33°C versus 36°C after cardiac arrest.心脏骤停后 33°C 与 36°C 的目标温度管理。
N Engl J Med. 2013 Dec 5;369(23):2197-206. doi: 10.1056/NEJMoa1310519. Epub 2013 Nov 17.

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