Variation in the Management of Persistent Pulmonary Hypertension of the Newborn: A Survey of Physicians in Canada, Australia, and New Zealand
Variation in the Management of Persistent Pulmonary Hypertension of the Newborn: A Survey of Physicians in Canada, Australia, and New Zealand
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DOI：
10.1055/s-0032-1310523
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发表时间：
2012-08-01
影响因子：
2
通讯作者：
McNamara, Patrick
中科院分区：
文献类型：
--
作者：
Shivananda, Sandesh;Ahliwahlia, Lucia;McNamara, Patrick
背景尽管新生儿持续性肺动脉高压(PPHN)的治疗取得了进展，但死亡和不良神经后遗症的风险仍然很高。目的评估加拿大和澳大利亚-新西兰地区(AUS-NZ)的重症监护实践。方法对新生儿科医生进行前瞻性的在线横断面调查。开发、验证和试点了一份包含35个项目的问卷，以收集关于诊断、吸入一氧化氮(INO)做法、替代血管扩张剂或心脏起搏剂以及超声心动图的信息。结果收集了217名调查对象的数据。超声心动图和动脉血气是评估PPHN严重程度的最常见的诊断方法。INO管理在加拿大受到更频繁的审查(36%对10%[澳大利亚-新西兰]，p<；0.001)。加拿大医生报告说，静脉注射米力农(p<；0.001)、加压素(p=0.02)和吸入前列环素(p=0.02)的使用率较高，但西地那非的使用率较低(p=0.01)。在澳大利亚-新西兰，更大比例的新生儿医生接受了超声心动图(P<；0.001)的培训，以优化治疗决策。有必要就PPHN的管理原则提供更多的指导，同时认识到个体患者心肺生理学的动态性质。
Background Despite advances in management of persistent pulmonary hypertension of the newborn (PPHN), the risk of mortality and adverse neurological sequelae remains high. Characterizing variation in practices is a crucial step toward improved patient outcome.Objective Evaluate intensive care practices in Canada and the Australia-New Zealand region (AUS-NZ).Methods A prospective cross-sectional online survey of neonatologists was conducted. A 35-item questionnaire was developed, validated, and piloted to collect information on diagnosis, inhaled nitric oxide (iNO) practices, alternative vasodilators or cardiotropes, and echocardiography. Variation among survey respondents as well as intergroup comparison was performed.Results Data were collected from 217 respondents. Echocardiography and arterial blood gas were the most common diagnostic tests to assess the severity of PPHN. iNO administration is more frequently scrutinized in Canada (36% versus 10% [AUS-NZ], p < 0.001). Canadian physicians reported higher use of intravenous milrinone (p < 0.001), vasopressin (p = 0.02), and inhaled prostacyclin (p = 0.02), but lower use of sildenafil (p = 0.01) for refractory pulmonary hypertension. A greater proportion of neonatologists in AUS-NZ were trained to perform echocardiography (p < 0.001) to optimize treatment decisions.Conclusion Wide variation exists in the management of PPHN. There is a need to providemore guidance regarding principles of management in PPHN, while recognizing the dynamic nature of cardiopulmonary physiology in individual patients.