Factors Associated With Continuous Low-Dose Heparin Infusion for Central Venous Catheter Patency in Critically Ill Children Worldwide.
Factors Associated With Continuous Low-Dose Heparin Infusion for Central Venous Catheter Patency in Critically Ill Children Worldwide.
复制标题
全球危重儿童持续低剂量肝素输注以保证中心静脉导管通畅的相关因素。
DOI：
10.1097/pcc.0000000000000854
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发表时间：
2016
期刊：
影响因子：
--
通讯作者：
ProphylaxisagainstThrombosisPracticeStudyInvestigators
中科院分区：
文献类型：
--
作者：
Onyeama,Sara-JaneN;Hanson,SheilaJ;Dasgupta,Mahua;Hoffmann,RaymondG;Faustino,EdwardVincentS;ProphylaxisagainstThrombosisPracticeStudyInvestigators
目的：确定可能影响危重儿童中心静脉导管通畅使用小剂量肝素输注的患者、医院和中心静脉导管的因素。设计：一项国际多中心观察性研究的二次分析。地点：2012年，在4个研究日期中的59个PICU，涉及7个国家。患者：18岁以下使用中心静脉导管的儿童，他们被纳入一个参与单位，并参加了已完成的预防血栓的实践研究。所有溢出的患者都被排除在外。干预：无。测量和主要结果：在预防血栓实践研究的2484名患者中，1312名患者使用了中心静脉导管。这些患者中有5.7人使用了低剂量的肝素输注。使用卡方检验、Mann-Whitney U检验和Fisher精确检验比较不同患者、医院和中心静脉导管因素中小剂量肝素输注的频率。在多变量分析中，年龄不是小剂量肝素输注的显著因素。有肺动脉高压的患者减少了低剂量肝素输注，而那些积极手术或创伤诊断的患者增加了低剂量肝素输注。与外周中心静脉插管相比，所有中心静脉插管更有可能使用低剂量肝素输注。亚太地区、社区医院和较小的ICU(10张病床)显示低剂量肝素输注的使用增加。结论：患者、中心静脉导管和医院因素与危重儿童使用低剂量肝素输注有关。评估小剂量肝素输注的有效性和持久性还需要进一步的研究。
Objectives:To identify patient, hospital, and central venous catheter factors that may influence the use of low-dose heparin infusion for central venous catheter patency in critically ill children.Design:Secondary analysis of an international multicenter observational study.Setting:Fifty-nine PICUs over four study dates in 2012, involving seven countries.Patients:Children less than 18 years old with a central venous catheter who were admitted to a participating unit and enrolled in the completed Prophylaxis against Thrombosis Practice study were included. All overflow patients were excluded.Interventions:None.Measurements and Main Results:Of the 2,484 patients in the Prophylaxis against Thrombosis Practice study, 1,312 patients had a central venous catheter. Five hundred seven of those patients used low-dose heparin infusion. The frequency of low-dose heparin infusion was compared across various patient, hospital, and central venous catheter factors using chi-square, Mann-Whitney U, and Fisher exact tests. In the multivariate analysis, age was not a significant factor for low-dose heparin infusion use. Patients with pulmonary hypertension had decreased low-dose heparin infusion use, whereas those with active surgical or trauma diagnoses had increased low-dose heparin infusion use. All centrally inserted central venous catheters were more likely to use low-dose heparin infusion when compared with peripherally inserted central venous catheters. The Asia-Pacific region showed increased low-dose heparin infusion use, along with community hospitals and smaller ICUs (< 10 beds).Conclusions:Patient, central venous catheter, and hospital factors are associated with the use of low-dose heparin infusion in critically ill children. Further study is needed to evaluate the efficacy and persistence of low-dose heparin infusion use.