Executive Summary of the Second International Guidelines for the Diagnosis and Management of Pediatric Acute Respiratory Distress Syndrome (PALICC-2).
Executive Summary of the Second International Guidelines for the Diagnosis and Management of Pediatric Acute Respiratory Distress Syndrome (PALICC-2).
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DOI：
10.1097/pcc.0000000000003147
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发表时间：
2023-02-01
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我们试图更新我们在第二届儿科急性肺损伤共识会议（PALICC-2）儿科急性呼吸窘迫综合征（PARDS）诊断和管理指南中的2015年工作，考虑了以前未涉及的新证据和主题领域。国际共识会议系列，涉及PARDS的52名多学科国际内容专家和来自15个国家的4名方法学专家，使用共识会议方法和实施科学。不适用因患有PARDS或有PARDS风险的患者。没有。11个亚组对11个主题领域进行了系统或范围审查：1）定义、发生率和流行病学; 2）病理生物学、严重程度和风险分层; 3）呼吸支持; 4）肺部特异性辅助治疗; 5）非肺部治疗; 6）监测; 7）无创呼吸支持; 8）体外支持; 9）发病率和长期结局; 10）临床信息学和数据科学;以及11）资源有限的环境。检索包括MEDLINE、EMBASE和CINAHL Complete（EBSCOhost），并于2022年3月更新。建议分级、评估、制定和评价方法用于总结证据并制定建议，这些建议由所有PalICC-2专家进行讨论和投票。共有146项建议和声明，包括：34项临床实践建议; 112项基于共识的声明，其中18项关于PARDS定义，55项关于良好实践，7项关于政策，32项关于研究。所有建议和声明的一致性均超过80%。PALICC-2建议和基于共识的声明应有助于PARDS患者实施和遵守最佳临床实践。这些结果还将为未来研究项目的发展提供信息，这些研究项目是至关重要的，可以提供更有力的证据来指导儿科重症监护团队管理这些患者。
We sought to update our 2015 work in the Second Pediatric Acute Lung Injury Consensus Conference (PALICC-2) guidelines for the diagnosis and management of pediatric acute respiratory distress syndrome (PARDS), considering new evidence and topic areas that were not previously addressed. International consensus conference series involving 52 multidisciplinary international content experts in PARDS and four methodology experts from 15 countries, using consensus conference methodology, and implementation science. Not applicable. Patients with or at risk for PARDS. None. Eleven subgroups conducted systematic or scoping reviews addressing 11 topic areas: 1) definition, incidence, and epidemiology; 2) pathobiology, severity, and risk stratification; 3) ventilatory support; 4) pulmonary-specific ancillary treatment; 5) nonpulmonary treatment; 6) monitoring; 7) noninvasive respiratory support; 8) extracorporeal support; 9) morbidity and long-term outcomes; 10) clinical informatics and data science; and 11) resource-limited settings. The search included MEDLINE, EMBASE, and CINAHL Complete (EBSCOhost) and was updated in March 2022. Grading of Recommendations, Assessment, Development, and Evaluation methodology was used to summarize evidence and develop the recommendations, which were discussed and voted on by all PALICC-2 experts. There were 146 recommendations and statements, including: 34 recommendations for clinical practice; 112 consensus-based statements with 18 on PARDS definition, 55 on good practice, seven on policy, and 32 on research. All recommendations and statements had agreement greater than 80%. PALICC-2 recommendations and consensus-based statements should facilitate the implementation and adherence to the best clinical practice in patients with PARDS. These results will also inform the development of future programs of research that are crucially needed to provide stronger evidence to guide the pediatric critical care teams managing these patients.