Intensive care treatments associated with favorable discharge outcomes in Argentine children with severe traumatic brain injury: For the South American Guideline Adherence Group.
Intensive care treatments associated with favorable discharge outcomes in Argentine children with severe traumatic brain injury: For the South American Guideline Adherence Group.
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DOI：
10.1371/journal.pone.0189296
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发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
Petroni GJ
中科院分区：
文献类型：
--
作者：
Vavilala MS;Lujan SB;Qiu Q;Bell MJ;Ballarini NM;Guadagnoli N;Depetris MA;Faguaga GA;Baggio GM;Busso LO;García ME;González Carrillo OR;Medici PL;Sáenz SS;Vanella EE;Farr CK;Petroni GJ
在中低收入国家，对创伤性脑损伤（TBI）儿童的重症监护管理知之甚少。我们的目的是确定重症监护病房（ICU）治疗与阿根廷严重TBI患儿预后相关的指标。我们对先前参加一项前瞻性七中心研究的重症TBI儿童患者的数据进行了二次分析，这些患者在七个研究中心之一的ICU住院。重度TBI的定义为头部AIS≥3，头部CT有外伤性病变，入院GCS < 9。检查了最佳实践TBI护理的七个指标。主要观察指标为出院儿童脑功能分类量表（PCPC）和儿童整体表现分类量表（POPC）。我们还检查了ICU护理和住院病人死亡率的差异。117名儿童中，67%为男性，平均7.5（4.3）岁，92%为孤立性脑外伤。低血压（54%）比缺氧（28%）更常见，临床或影像学表现为高颅内压（ICP）的比例为92%。然而，60%的患者进行了ICP监测，只有36%的患者使用了高渗治疗。七个中心对最佳TBI实践指标的依从性范围为55.6%至83.7%，依从性与良好的出院PCPC （aRR 0.98; 95% CI[0.96, 0.99]）和POPC （aRR 0.98; 95% CI[0.96, 0.99]）相关。与依从率低于65%的患者相比，依从率在75%-100%之间的患者的出院PCPC （aRR 0.28; 95% CI[0.10, 0.83]）和POPC （aRR 0.32; 95% CI[0.15, 0.73]）更好。两项指标与良好的出院PCPC相关：避免缺氧（aRR 0.46; 95% CI[0.23, 0.93]）和72小时内开始营养（aRR 0.45; 95% CI[0.21, 0.99]）。避免缺氧也与良好的放电POPC相关（aRR 0.47; 95% CI[0.22, 0.99]）。阿根廷重症监护室在重症脑外伤患儿的护理实践中存在差异。二次损伤是常见的，高渗疗法的使用是罕见的。通过避免缺氧和及时提供营养来坚持最佳实践TBI护理与显著有利的出院结果相关。迫切需要在icu中实施预防缺氧和促进早期营养的策略，以改善儿童TBI的预后。
Little is known about the critical care management of children with traumatic brain injury (TBI) in low middle income countries. We aimed to identify indicators of intensive care unit (ICU) treatments associated with favorable outcomes in Argentine children with severe TBI. We conducted a secondary analysis of data from patients previously enrolled in a prospective seven center study of children with severe TBI who were admitted to an ICU in one of the seven study centers. Severe TBI was defined by head AIS ≥ 3, head CT with traumatic lesion, and admission GCS < 9. Seven indicators of best practice TBI care were examined. The primary outcome was discharge Pediatric Cerebral Performance Category Scale [PCPC] and Pediatric Overall Performance category Scale [POPC]. We also examined variation in ICU care and in-patient mortality. Of the 117 children, 67% were male and 7.5 (4.3) years on average, 92% had isolated TBI. Hypotension (54%) was more common than hypoxia (28%) and clinical or radiographic signs of high intracranial pressure (ICP) were observed in 92%. Yet, ICP monitoring occurred in 60% and hyperosmolar therapy was used in only 36%. Adherence to indicators of best TBI practice ranged from 55.6% to 83.7% across the seven centers and adherence was associated with favorable discharge PCPC (aRR 0.98; 95% CI [0.96, 0.99]), and POPC (aRR 0.98; 95% CI [0.96, 0.99]). Compared to patients whose adherence rates were below 65%, patients whose adherence rates were higher between 75%-100% had better discharge PCPC (aRR 0.28; 95% CI [0.10, 0.83]) and POPC (aRR 0.32; 95% CI [0.15, 0.73]. Two indicators were associated with favorable discharge PCPC: Avoidance of hypoxia (aRR 0.46; 95% CI [0.23, 0.93]), and Nutrition started in 72 hours (aRR 0.45; 95% CI [0.21, 0.99]). Avoiding hypoxia was also associated with favorable discharge POPC (aRR 0.47; 95% CI [0.22, 0.99]). There is variation in Argentine ICU practice in the care of children with severe TBI. Second insults are common and hyperosmolar therapy use is uncommon. Adherence to best practice TBI care by avoiding hypoxia and providing timely nutrition were associated with significantly favorable discharge outcomes. Implementing strategies that prevent hypoxia and facilitate early nutrition in the ICUs are urgently needed to improve pediatric TBI outcomes.
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影响因子：
8.8
作者：
Vavilala MS;Kernic MA;Wang J;Kannan N;Mink RB;Wainwright MS;Groner JI;Bell MJ;Giza CC;Zatzick DF;Ellenbogen RG;Boyle LN;Mitchell PH;Rivara FP;Pediatric Guideline Adherence and Outcomes Study
通讯作者：
Pediatric Guideline Adherence and Outcomes Study
DOI：
10.4103/2229-5151.79279
发表时间：
2011-01-01
影响因子：
--
作者：
Curry, Parichat;Viernes, Darwin;Sharma, Deepak
通讯作者：
Sharma, Deepak
DOI：
10.1097/ta.0b013e3181ad32c7
发表时间：
2009-08-01
影响因子：
--
作者：
Philip, Shaji;Udomphorn, Yuthana;Vavilala, Monica S.
通讯作者：
Vavilala, Monica S.
DOI：
10.1111/pan.12415
发表时间：
2014-07
期刊：
Paediatric anaesthesia
影响因子：
--
作者：
Hardcastle N;Benzon HA;Vavilala MS
通讯作者：
Vavilala MS
DOI：
10.1097/pcc.0000000000000772
发表时间：
2016-07
期刊：
Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
影响因子：
--
作者：
Carney NA;Petroni GJ;Luján SB;Ballarini NM;Faguaga GA;du Coudray HE;Huddleston AE;Baggio GM;Becerra JM;Busso LO;Dikmen SS;Falcone R;García ME;González Carrillo OR;Medici PL;Quaglino MB;Randisi CA;Sáenz SS;Temkin NR;Vanella EE
通讯作者：
Vanella EE