Potential Acceptability of a Pediatric Ventilator Management Computer Protocol.
Potential Acceptability of a Pediatric Ventilator Management Computer Protocol.
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儿科呼吸机管理计算机协议的潜在可接受性。
DOI：
10.1097/pcc.0000000000001331
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发表时间：
2017
期刊：
影响因子：
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通讯作者：
D
中科院分区：
文献类型：
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作者：
Sward,KatherineA;Newth,ChristopherJL;Khemani,RobinderG;Page,Kent;Meert,KathleenL;Carcillo,JosephA;Shanley,ThomasP;Moler,FrankW;Pollack,MurrayM;Dalton,HeidiJ;Wessel,DavidL;Berger,JohnT;Berg,RobertA;Harrison,RickE;D
目的：检查小儿急性呼吸窘迫综合征儿童呼吸机管理方案中建议的粒度（大小/规模）和潜在可接受性问题。设计：调查/问卷。设置：儿科重症监护协作研究网络中的八个 PICU。参与者：122 名医生（主治医生和研究员）。干预措施：无。测量和主要结果：我们使用在线调查问卷来检查态度和评估建议具有 50 个临床场景。总体而言，80% 的场景建议被接受。接受度不会因提供者特征而变化，但会因呼吸机模式（高频振荡通气 83%、压力调节容量控制 82%、压力控制 75%；p= 0.002）和变量调整（范围从吸气峰值压力的 88% 和 F io 2 变化的 86% 到呼气末正压变化的 69%）而变化。接受程度不会因儿童体型/年龄而异。人们倾向于较小的呼气末正压变化，但对其他变量没有明确的粒度偏好。结论：尽管场景的总体接受率良好，但对于小儿急性呼吸窘迫综合征儿童呼吸机设置变化的大小/范围几乎没有达成共识。可接受的方案可以支持对呼吸机管理策略的稳健评估。需要进一步的研究来确定遵守明确的方案是否会带来更好的结果。
Objectives:To examine issues regarding the granularity (size/scale) and potential acceptability of recommendations in a ventilator management protocol for children with pediatric acute respiratory distress syndrome.Design:Survey/questionnaire.Setting:The eight PICUs in the Collaborative Pediatric Critical Care Research Network.Participants:One hundred twenty-two physicians (attendings and fellows).Interventions:None.Measurements and Main Results:We used an online questionnaire to examine attitudes and assessed recommendations with 50 clinical scenarios. Overall 80% of scenario recommendations were accepted. Acceptance did not vary by provider characteristics but did vary by ventilator mode (high-frequency oscillatory ventilation 83%, pressure-regulated volume control 82%, pressure control 75%; p= 0.002) and variable adjusted (ranging from 88% for peak inspiratory pressure and 86% for F io 2 changes to 69% for positive end-expiratory pressure changes). Acceptance did not vary based on child size/age. There was a preference for smaller positive end-expiratory pressure changes but no clear granularity preference for other variables.Conclusions:Although overall acceptance rate for scenarios was good, there was little consensus regarding the size/scale of ventilator setting changes for children with pediatric acute respiratory distress syndrome. An acceptable protocol could support robust evaluation of ventilator management strategies. Further studies are needed to determine if adherence to an explicit protocol leads to better outcomes.