Ventilatory Support in Children With Pediatric Acute Respiratory Distress Syndrome: Proceedings From the Pediatric Acute Lung Injury Consensus Conference
Ventilatory Support in Children With Pediatric Acute Respiratory Distress Syndrome: Proceedings From the Pediatric Acute Lung Injury Consensus Conference
复制标题
小儿急性呼吸窘迫综合征患儿的通气支持：小儿急性肺损伤共识会议纪要
DOI：
10.1097/pcc.0000000000000433
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发表时间：
2015-06-01
影响因子：
4.1
通讯作者：
Cheifetz, Ira M.
中科院分区：
文献类型：
--
作者：
Rimensberger, Peter C.;Cheifetz, Ira M.
目的：描述儿科急性肺损伤共识会议对小儿急性呼吸窘迫综合征患者机械通气管理的建议。设计：儿科急性肺损伤专家共识会议。方法：儿科急性肺损伤共识会议专家制定并表决了27项关于小儿急性呼吸窘迫综合征患者最佳机械通气方式的建议。主题包括呼吸机模式、潮气量输送、吸气平台压、高频呼吸机、带袖套的气管内导管和气体交换目标。在缺乏实验数据的情况下，采用改进的德尔菲法，强调强烈的专业一致性。结果：有17个建议具有强一致性，10个建议具有弱一致性。没有平衡或不一致的建议。在有关潮气量和吸气压力限制的建议上有微弱的一致(分别有88%到72%的一致)，而在接受允许性高碳酸血症方面有很大的一致。强烈推荐在严重的儿童急性呼吸窘迫综合征中使用大于15 cm H2O的呼气末正压，条件是随着呼气末正压的增加，密切监测氧输送、呼吸系统顺应性和血流动力学的标志物。在常规机械通气中探索仔细的复张手法的效果的概念达到了88%的一致性水平，而在抢救高频振荡呼吸机中使用复张动作是强烈推荐的(强烈一致)。结论：共识会议制定了针对儿科急性呼吸窘迫综合征患者的机械通气的具体建议以及未来的研究重点。这些建议旨在启动关于儿童急性呼吸窘迫综合征最佳机械通气管理的讨论，并确定需要进一步调查的争议领域。
Objective: To describe the recommendations of the Pediatric Acute Lung Injury Consensus Conference for mechanical ventilation management of pediatric patients with acute respiratory distress syndrome.Design: Consensus Conference of experts in pediatric acute lung injury.Methods: The Pediatric Acute Lung Injury Consensus Conference experts developed and voted on a total of 27 recommendations focused on the optimal mechanical ventilation approach of the patient with pediatric acute respiratory distress syndrome. Topics included ventilator mode, tidal volume delivery, inspiratory plateau pressure, high-frequency ventilation, cuffed endotracheal tubes, and gas exchange goals. When experimental data were lacking, a modified Delphi approach emphasizing the strong professional agreement was used.Results: There were 17 recommendations with strong agreement and 10 recommendations with weak agreement. There were no recommendations with equipoise or disagreement. There was weak agreement on recommendations concerning approach to tidal volume and inspiratory pressure limitation (88% to 72% agreement, respectively), whereas strong agreement could be achieved for accepting permissive hypercapnia. Using positive end-expiratory pressure levels greater than 15 cm H2O in severe pediatric acute respiratory distress syndrome, under the condition that the markers of oxygen delivery, respiratory system compliance, and hemodynamics are closely monitored as positive end-expiratory pressure is increased, is strongly recommended. The concept of exploring the effects of careful recruitment maneuvers during conventional ventilation met an agreement level of 88%, whereas the use of recruitment maneuvers during rescue high-frequency oscillatory ventilation is highly recommended (strong agreement).Conclusions: The Consensus Conference developed pediatric-specific recommendations regarding mechanical ventilation of the patient with pediatric acute respiratory distress syndrome as well as future research priorities. These recommendations are intended to initiate discussion regarding optimal mechanical ventilation management for children with pediatric acute respiratory distress syndrome and identify areas of controversy requiring further investigation.