Determining Optimal Outcome Measures in a Trial Investigating No Routine Gastric Residual Volume Measurement in Critically Ill Children.
Determining Optimal Outcome Measures in a Trial Investigating No Routine Gastric Residual Volume Measurement in Critically Ill Children.
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在一项研究危重儿童未进行常规胃残留量测量的试验中确定最佳结果措施。
DOI：
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发表时间：
2020
期刊：
影响因子：
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通讯作者：
J. Dorling
中科院分区：
文献类型：
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作者：
L. Tume;B. Arch;K. Woolfall;L. Roper;E. Deja;Ashley P. Jones;L. Latten;H. Eccleson;H. Hickey;N. Pathan;J. Preston;A. Beissel;I. Andrzejewska;C. Gale;F. Valla;J. Dorling
背景
选择试验结果衡量标准很重要。当结果与临床无关或对父母/患者不重要时，试验证据不太可能付诸实践。这项研究旨在确定危重儿童非常规胃残留量(GRV)试验的最佳结果。
方法
采用了一种混合方法：有重点的文献综述、家长和临床医生访谈、修改后的两轮德尔菲法和利益相关者共识会议。
结果
审查产生了13个结果。14名儿科重症监护病房(PICU)的父母提出了3项额外的结果；这16项结果随后在德尔福第一轮中由28名临床医生进行了评级。6项进一步的结果被提出，22项结果在第二轮中被评估。没有任何项目被投票“一致通过”。30名与会者在一次面对面的会议上投票表决了这18个没有达成共识的项目。最后12项结果指标是达到能量目标的时间、呼吸机相关性肺炎、呕吐、每24小时停止肠内喂养的时间、坏死性小肠结肠炎、有创机械通气时间、PICU住院时间、死亡率、体重变化和饲料不耐受标志物(给予肠外营养)、改变饲料配方、改变喂养时间，所有这些都是继发于饲料不耐受的。
结论
我们通过一个多阶段的过程，通过征求父母和临床医生的意见，确定了无GRV测量试验的12种结果。
BACKGROUND
Choosing trial outcome measures is important. When outcomes are not clinically relevant or important to parents/patients, trial evidence is less likely to be implemented into practice. This study aimed to determine optimal outcome measures for a trial of no routine gastric residual volume (GRV) measurement in critically ill children.
METHODS
A mixed-methods approach was used: a focused literature review, parent and clinician interviews, a modified 2-round Delphi, and a stakeholder consensus meeting.
RESULTS
The review generated 13 outcomes. Fourteen pediatric intensive care unit (PICU) parents proposed 3 additional outcomes; these 16 were then rated by 28 clinicians in Delphi round 1. Six further outcomes were proposed, and 22 outcomes were rated in the second round. No items were voted "consensus out." The 18 "no-consensus" items were voted in a face-to-face meeting by 30 participants. The final 12 outcome measures were time to reach energy targets, ventilator-associated pneumonia, vomiting, time enteral feeds withheld per 24 hours, necrotizing enterocolitis, length of invasive ventilation, PICU length of stay, mortality, change in weight and markers of feed intolerance (parenteral nutrition administered), feed formula altered, and change to postpyloric feeds all secondary to feed intolerance.
CONCLUSION
We have identified 12 outcomes for a trial of no GRV measurement through a multistage process, seeking views of parents and clinicians.