Challenges in pediatric post-sepsis care in resource limited settings: a narrative review.
Challenges in pediatric post-sepsis care in resource limited settings: a narrative review.
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DOI：
10.21037/tp-20-390
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发表时间：
2021-10
影响因子：
2
通讯作者：
Holsti L
中科院分区：
文献类型：
--
作者：
Wiens MO;Kissoon N;Holsti L
本叙述性综述的目的是概述当前脓毒症康复背景下的流行病学和干预性研究，并总结该领域未来工作的重点。败血症继发的发病率和死亡率对儿童的影响不成比例，特别是低收入和中等收入国家（LMIC）的儿童，全球85%以上的病例和死亡发生在这些国家。这些地区的卫生系统复原力差，社会经济贫困现象普遍，营养不良等独特的脆弱性。减少脓毒症的总体负担将需要多管齐下的策略，解决脓毒症护理连续体沿着所有三个重要阶段-设施前，设施和设施后。在这些方面中，设施后问题在很大程度上被忽视的研究，实践和政策，因此是本次审查的重点。通过使用PubMed进行文献检索，通过对选定系统性综述的引文进行审查，并从作者收集的文章的个人存储库中确定了本综述的相关数据。数据分三节列出。前两个部分分别概述了败血症幸存者的短期和长期结局的流行病学，并回顾了相关的干预研究。如果存在明显差距，则说明这些差距。第三部分着重于未来研究的重点。本节强调了数据（和数据系统）和创新干预方法的重要性，作为改善儿童脓毒症后结局研究的关键领域。在设施建成后的最初阶段，死亡率很高，在这一阶段死亡的儿童人数与住院治疗的急性期一样多，主要是由于与营养不良和严重急性病有关的复发性疾病（包括感染）。长期结果，通常被标记为脓毒症后综合征（PSS），其特征是发育里程碑和次优生活质量（QoL）的滞后。虽然在资源有限的情况下，长期结果尚未得到很好的描述，但在高收入国家（HIC）中得到了很好的描述，并且可能是资源有限情况下长期发病率的重要因素。改善出院后结局（短期或长期）的干预性研究的缺乏是解决其负担的一个明显差距。在改善脓毒症后阶段结果的任何努力中，都需要优先考虑开发用于收集常规数据的改进数据系统、标准化定义和术语以及研究中的卫生系统方法。
The objective of this narrative review is to outline the current epidemiology and interventional research within the context of sepsis recovery, and to provide a summary of key priorities for future work in this area. Morbidity and mortality secondary to sepsis disproportionately affects children, especially those in low- and middle-income countries (LMICs), where over 85% of global cases and deaths occur. These regions are plagued by poorly resilient health systems, widespread socio-economic deprivation and unique vulnerabilities such as malnutrition. Reducing the overall burden of sepsis will require a multi-pronged strategy that addresses all three important periods along the sepsis care continuum - pre-facility, facility and post-facility. Of these aspects, post-facility issues have been largely neglected in research, practice and policy, and are thus the focus of this review. Relevant data for this review was identified through a literature search using PubMed, through a review of the citations of select systematic reviews and from the personal repositories of articles collected by the authors. Data is presented within three sections. The first two sections on the short and long-term outcomes among sepsis survivors each outline the epidemiology as well as review relevant interventional research done. Where clear gaps exist, these are stated. The third section focuses on priorities for future research. This section highlights the importance of data (and data systems) and of innovative interventional approaches, as key areas to improve research of post-sepsis outcomes in children. During the initial post-facility period, mortality is high with as many children dying during this period as during the acute period of hospitalization, mostly due to recurrent illness (including infections) which are associated with malnutrition and severe acute disease. Long-term outcomes, often labelled as post-sepsis syndrome (PSS), are characterized by a lag in developmental milestones and suboptimal quality of life (QoL). While long-term outcomes have not been well characterized in resource limited settings, they are well described in high-income countries (HICs), and likely are important contributors to long-term morbidity in resource limited settings. The paucity of interventional research to improve post-discharge outcomes (short- or long-term) is a clear gap in addressing its burden. A focus on the development of improved data systems for collecting routine data, standardized definitions and terminology and a health-systems approach in research need to be prioritized during any efforts to improve outcomes during the post-sepsis phase.
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