北美儿科重症监护病房神经监测实践调查。
A Survey of Neuromonitoring Practices in North American Pediatric Intensive Care Units.
机构信息
Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
出版信息
Pediatr Neurol. 2022 Jan;126:125-130. doi: 10.1016/j.pediatrneurol.2021.11.002. Epub 2021 Nov 12.
BACKGROUND
Neuromonitoring is the use of continuous measures of brain physiology to detect clinically important events in real-time. Neuromonitoring devices can be invasive or non-invasive and are typically used on patients with acute brain injury or at high risk for brain injury. The goal of this study was to characterize neuromonitoring infrastructure and practices in North American pediatric intensive care units (PICUs).
METHODS
An electronic, web-based survey was distributed to 70 North American institutions participating in the Pediatric Neurocritical Care Research Group. Questions related to the clinical use of neuromonitoring devices, integrative multimodality neuromonitoring capabilities, and neuromonitoring infrastructure were included. Survey results were presented using descriptive statistics.
RESULTS
The survey was completed by faculty at 74% (52 of 70) of institutions. All 52 institutions measure intracranial pressure and have electroencephalography capability, whereas 87% (45 of 52) use near-infrared spectroscopy and 40% (21/52) use transcranial Doppler. Individual patient monitoring decisions were driven by institutional protocols and collaboration between critical care, neurology, and neurosurgery attendings. Reported device utilization varied by brain injury etiology. Only 15% (eight of 52) of institutions utilized a multimodality neuromonitoring platform to integrate and synchronize data from multiple devices. A database of neuromonitoring patients was maintained at 35% (18 of 52) of institutions. Funding for neuromonitoring programs was variable with contributions from hospitals (19%, 10 of 52), private donations (12%, six of 52), and research funds (12%, six of 52), although 73% (40 of 52) have no dedicated funds.
CONCLUSIONS
Neuromonitoring indications, devices, and infrastructure vary by institution in North American pediatric critical care units. Noninvasive modalities were utilized more liberally, although not uniformly, than invasive monitoring. Further studies are needed to standardize the acquisition, interpretation, and reporting of clinical neuromonitoring data, and to determine whether neuromonitoring systems impact neurological outcomes.
背景
神经监测是利用连续的脑生理测量来实时检测临床重要事件。神经监测设备可以是有创的，也可以是无创的，通常用于急性脑损伤或有脑损伤高风险的患者。本研究的目的是描述北美儿科重症监护病房（PICU）的神经监测基础设施和实践。
方法
采用电子网络问卷调查了参与儿科神经危重病研究组的 70 家北美机构。调查问卷包括神经监测设备的临床应用、综合多模态神经监测能力和神经监测基础设施等相关问题。使用描述性统计方法呈现调查结果。
结果
该调查由 70 家机构中的 74%（52 家）的教员完成。所有 52 家机构均测量颅内压，并具备脑电图能力，其中 87%（45 家）使用近红外光谱，40%（21 家）使用经颅多普勒。个体患者监测决策由机构协议和重症监护、神经科和神经外科主治医生之间的协作驱动。报告的设备利用率因脑损伤病因而异。只有 15%（52 家中的 8 家）的机构使用多模态神经监测平台整合和同步来自多个设备的数据。35%（52 家中的 18 家）的机构维护有神经监测患者数据库。神经监测项目的资金来源各不相同，包括医院（19%，52 家中的 10 家）、私人捐款（12%，52 家中的 6 家）和研究基金（12%，52 家中的 6 家），尽管 73%（52 家中的 40 家）没有专门的资金。
结论
北美儿科重症监护病房的神经监测适应证、设备和基础设施因机构而异。与有创监测相比，无创监测的应用更为广泛，但并非普遍如此。需要进一步的研究来标准化临床神经监测数据的获取、解释和报告，并确定神经监测系统是否影响神经学结局。
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