Differences in Medical Therapy Goals for Children With Severe Traumatic Brain Injury-An International Study
Differences in Medical Therapy Goals for Children With Severe Traumatic Brain Injury-An International Study
复制标题
DOI：
10.1097/pcc.0b013e3182975e2f
复制
发表时间：
2013-10-01
影响因子：
4.1
通讯作者：
Wisniewski, Stephen R.
中科院分区：
文献类型：
--
作者：
Bell, Michael J.;Adelson, P. David;Wisniewski, Stephen R.
目的：描述一些国际中心对严重创伤性脑损伤儿童的各种医学治疗通常做法的目标差异。设计：对国际中心代表的目标进行调查。环境：美国、英国、法国和西班牙的32个儿童创伤性脑损伤中心。病人:没有。干预措施:没有。测量结果和主要结果：我们开发了一种调查工具，要求各中心就其颅内高压治疗、缺氧/缺血预防和检测以及代谢支持等主题的常规实践目标提供自由形式的回答。脑脊液分流策略在中心间和中心内均存在差异，采用持续脑脊液分流策略和不采用脑脊液分流策略的中心比例大致相等。甘露醇和高渗生理盐水用于高渗治疗在各中心广泛使用（分别为90.1%和96.9%）。在使用高渗生理盐水的中心，3%的生理盐水制剂是最常见的，但许多其他浓度也被普遍使用。常规过度通气未被报道为标准目标，31.3%的中心目前使用Pbo(2)监测脑缺氧。开始营养支持和葡萄糖给药的时间差别很大，在大多数中心，营养支持在96小时前开始，葡萄糖给药开始得更早。结论：在我们的国际联盟中，严重创伤性脑损伤儿童的医疗目标存在显著差异，这些差异似乎在文献中证据最薄弱的领域最大。未来的研究将确定我们调查中列出的各种医学疗法的优越性，这将是儿科神经创伤领域的重大进步，并可能导致新的护理标准和改进临床试验的研究设计。
Objectives: To describe the differences in goals for their usual practice for various medical therapies from a number of international centers for children with severe traumatic brain injury.Design: A survey of the goals from representatives of the international centers.Setting: Thirty-two pediatric traumatic brain injury centers in the United States, United Kingdom, France, and Spain.Patients: None.Interventions: None.Measurements and Main Results: A survey instrument was developed that required free-form responses from the centers regarding their usual practice goals for topics of intracranial hypertension therapies, hypoxia/ischemia prevention and detection, and metabolic support. Cerebrospinal fluid diversion strategies varied both across centers and within centers, with roughly equal proportion of centers adopting a strategy of continuous cerebrospinal fluid diversion and a strategy of no cerebrospinal fluid diversion. Use of mannitol and hypertonic saline for hyperosmolar therapies was widespread among centers (90.1% and 96.9%, respectively). Of centers using hypertonic saline, 3% saline preparations were the most common but many other concentrations were in common use. Routine hyperventilation was not reported as a standard goal and 31.3% of centers currently use Pbo(2) monitoring for cerebral hypoxia. The time to start nutritional support and glucose administration varied widely, with nutritional support beginning before 96 hours and glucose administration being started earlier in most centers.Conclusions: There were marked differences in medical goals for children with severe traumatic brain injury across our international consortium, and these differences seemed to be greatest in areas with the weakest evidence in the literature. Future studies that determine the superiority of the various medical therapies outlined within our survey would be a significant advance for the pediatric neurotrauma field and may lead to new standards of care and improved study designs for clinical trials.