Division of Critical Care, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
Transplant Division, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
Pediatr Transplant. 2021 Aug;25(5):e13976. doi: 10.1111/petr.13976. Epub 2021 Jan 27.
Advancements in critical care management have led to improvement in pediatric LT outcomes. However, there are no specific guidelines for many aspects of immediate post-LT care. This survey examines practice variations in the immediate postoperative care of pediatric LT patients at a large number of active US centers. This study is a cross-sectional survey of medical directors at PALISI-affiliated PICU in the United States. Centers performing pediatric LT were analyzed. Study measures included PICU practices regarding staffing, composition of the multidisciplinary team, early post-LT graft and patient monitoring, and anticoagulation. Of the thirty-five responding centers, twenty-five had a LT program which accounted for one-half of all US pediatric LTs. For analysis, centers were categorized by volume: high (7), medium (11), and low (7). The majority of PICU teams included an intensivist (80%) and hepatologist (84%). High-volume centers were less likely to have 24-hour in-house attending coverage (29%, compared to 64% (medium) and 100% (low)). High-volume centers were most likely to have pre-printed orders, but least likely to have written PICU management protocols. Most centers utilize routine daily liver ultrasound. Routine prophylactic anticoagulation, and the agent of choice, was variable. There is marked inconsistency in post-LT practice across PALISI centers in regards to team composition and immediate post-LT management. A national US consensus for post-LT PICU practices would facilitate outcomes research and would establish a platform for multicenter studies.
重症监护管理的进步导致儿科肝移植结局的改善。然而，对于许多即刻肝移植后护理的方面，目前还没有具体的指南。这项调查检查了美国众多活跃中心的儿科肝移植患者即刻术后护理的实践差异。本研究是对美国 PALISI 附属 PICU 的医学主任进行的横断面调查。分析了进行儿科肝移植的中心。研究措施包括 PICU 关于人员配备、多学科团队组成、肝移植后早期移植物和患者监测以及抗凝的实践。在 35 个回应的中心中，有 25 个有肝移植项目，占所有美国儿科肝移植的一半。为了进行分析，中心按数量分类：高（7）、中（11）和低（7）。大多数 PICU 团队包括一名重症监护医生（80%）和肝病专家（84%）。高容量中心的内部主治医生 24 小时值班的可能性较低（29%，而中容量和低容量中心分别为 64%和 100%）。高容量中心最有可能有预先印制的医嘱，但最不可能有书面的 PICU 管理方案。大多数中心都常规进行每日肝脏超声检查。常规预防性抗凝，以及首选的抗凝剂，存在差异。在 PALISI 中心，肝移植后实践在团队组成和即刻肝移植后管理方面存在显著的不一致性。美国全国范围内的肝移植后 PICU 实践共识将有助于开展结果研究，并为多中心研究建立平台。
