Goal-directed Resuscitative Interventions during Pediatric Inter-facility Transpo

儿科跨机构转运期间的目标导向复苏干预

• 批准号: 7990251
• 负责人: MICHAEL Hugh STROUD
• 金额: $ 22.05万
• 依托单位: ARKANSAS CHILDREN'S HOSPITAL RES INST
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-08-11 至 2012-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7990251
• 关键词: Academic Medical Centers; Adopted; Adoption; Adult; Arkansas; Arts; Blood Pressure Monitors; Caring; Cerebrum; Child; Childhood; Clinical; Communities; Community Hospitals; Controlled Clinical Trials; Craniocerebral Trauma; Critical Care; Critical Illness; Critically ill children; Data; Data Collection; Development; Early treatment; Effectiveness; Environment; Functional disorder; Future; Goals; Hypoxia; Incidence; Institution; Intensive Care Units; Intervention; Lead; Length; Length of Stay; Measurement; Measures; Medicine; Metabolism; Monitor; Morbidity - disease rate; Multiple Organ Failure; Near-Infrared Spectroscopy; Organ; Outcome; Outcome Measure; Oxygen; Patients; Pediatric Hospitals; Pilot Projects; Prevention; Protocols documentation; Randomized Controlled Trials; Resuscitation; Sepsis; Sepsis Syndrome; Shock; Surrogate Markers; System; Techniques; Technology; Testing; Therapeutic; Therapeutic Intervention; Tissues; Training; Venous; care delivery; cohort; improved; mortality; prevent; primary outcome; public health relevance; success; tertiary care; tissue oxygenation; trend

DESCRIPTION (provided by applicant): Recent advances in critical care medicine have dramatically improved morbidity and mortality of critical illness. Goal-directed therapy protocols have been instrumental in this change. Goal-directed therapy standardizes the rapid delivery of definitive care in illnesses such as SIRS (Systemic Inflammatory Response Syndrome) and head trauma. Although this treatment approach has been shown to improve clinical outcomes1,2, it has not been widely adopted outside academic medical centers. Further improvement in outcomes of critical illness is likely if goal-directed therapy is utilized early in the course of care. To facilitate this early adoption, goal-directed therapeutic protocols should be developed and implemented by specialized pediatric transport teams. We hypothesize that the institution of goal-directed therapy during pediatric inter- facility transport will improve the outcomes of critically ill children. The GRIPIT Trial (Goal-directed Resuscitative Interventions during Pediatric Inter-facility Transport) will compare outcomes of pediatric SIRS patients before and after the implementation of a goal-directed therapeutic protocol during transport. This will be the first test of goal-directed therapy in the transport environment. Data will be collected on pediatric SIRS patients transported by the Angel One Transport Team at Arkansas Children's Hospital before and after protocol implementation. Outcome measures will include length of hospital stay, length of intensive care unit (ICU) stay, incidence of multiple organ dysfunction syndrome (MODS), and required therapeutic interventions during ICU stay (TISS-28 scores). In addition, NIRS (Near-Infrared Spectroscopy) monitoring will be used as a cerebral and somatic oxygenation trend monitor, to determine its effectiveness as a resuscitation guide for pediatric SIRS during transport. NIRS trends are useful as a surrogate marker for systemic venous saturations, known to decrease with severe SIRS3. PUBLIC HEALTH RELEVANCE: The GRIPIT Trial will be the first test of goal-directed therapy in the transport environment. This study has the potential to change the current practice of pediatric inter-facility transport, and improve clinical outcomes of pediatric SIRS.

描述（由申请人提供）：重症监护医学的最新进展已大大提高了重症疾病的发病率和死亡率。目标指导的治疗方案对这一变化有用。目标定向的治疗标准化了在SIRS（系统性炎症反应综合征）和头部创伤等疾病中快速提供确定的护理。尽管已证明这种治疗方法可以改善临床结局1,2，但在学术医疗中心以外没有被广泛采用。如果在护理过程中使用目标指导的治疗，则可能会进一步改善重症疾病的结果。 为了促进这种早期采用，应由专业的儿科运输团队制定和实施目标指导的治疗方案。我们假设小儿间交通期间的目标定向治疗机构将改善重症儿童的结果。 GRIPIT试验（小儿跨诊断期间的目标指导的复苏干预措施）将比较在运输过程中实施目标指导的治疗方案之前和之后的小儿SIRS患者的预后。这将是运输环境中目标定向治疗的首次测试。将收集有关在协议实施之前和之后，由阿肯色州儿童医院的Angel One运输团队运送的小儿SIRS患者。结果指标将包括住院时间，重症监护病房的长度（ICU）住院时间，多器官功能障碍综合征（MOD）的发生率以及ICU停留期间所需的治疗干预措施（Tiss-28分数）。 此外，NIRS（近红外光谱）监测将用作脑氧合趋势监测仪，以确定其作为运输过程中小儿SIR的复苏指南的有效性。 NIRS趋势可作为系统性静脉饱和度的替代标记物，已知会随着严重的SIRS3降低。 公共卫生相关性：Gripit试验将是运输环境中目标定向治疗的首次测试。这项研究有可能改变当前的小儿际交通运输的实践，并改善小儿SIR的临床结果。