儿童重症监护病房医护人员对长期机械通气认知及管理现况的多中心调查

A multi-center survey of medical staffs′ cognition and management of prolonged mechanical ventilation in pediatric intensive care unit

目的调查我国儿童重症监护病房(PICU)医护人员对长期机械通气(PMV)的认知及临床管理现况,为提高PICU医护人员对PMV的认识、规范PMV患儿管理提供依据。方法于2020年7月12日至9月12日以全国儿童PMV协作组中PICU医生、护士为调查对象进行横断面研究,调查表由复旦大学附属儿科医院统一发放、收集和审核。结果(1)PMV相关资源配置:11家医院中,已成立PMV多学科医疗团队的有9家,开展呼吸评估技术如膈肌超声、气道峰流速监测的PICU分别占72.7%、36.4%;开展肺康复技术如气道廓清、诱发性肺量计训练、体外膈肌起搏仪刺激、转移床锻炼、吹气球、高压氧治疗的PICU分别占100.0%、9.1%、9.1%、9.1%、27.3%、27.3%。(2)儿童PMV疾病认知现况:认为PMV是指持续机械通气时间大于2周的医护人员最多(41.3%),60.0%医务人员认为PMV患儿存在中枢神经系统基础疾病,62.7%的医护人员认为导致PMV患儿撤机困难的最常见原因是脑功能异常。(3)儿童PMV在PICU内管理认知现况:被调查者认为PMV患儿在疾病稳定期最常使用的机械通气模式为同步间歇指令通气+压力支持通气。92.0%的医护人员撤机时会实施自主呼吸试验。58.7%的被调查者接受在机械通气3~4周时为患儿实施气管切开术。超过半数的医护人员会对PMV患儿实施膈肌功能评估、床旁康复训练、营养评估及镇痛镇静评估。(4)PMV患儿医院-家庭过渡管理认知现况:54.5%(6/11)的PICU会在患儿出院前对其家属提供家庭护理培训,1家中心设立了PMV专病门诊,45.5%的PICU会在患儿出院后1个月进行随访。结论目前国内PICU医务人员对于儿童PMV相关问题存在认知差异,儿童PMV缺乏系统化诊疗管理方案。

Objective To investigate the status of cognition and clinical management of prolonged mechanical ventilation(PMV)among medical staffs in pediatric intensive care unit(PICU)in China,and in order to improve the awareness of PICU medical staffs on PMV and standardize the management of PMV.Methods The cross-sectional study was conducted with doctors and nurses in PICUs of the collaborative group as the survey objects from July 12 to September 12,2020.The questionnaire was issued,collected and checked by the Children′s Hospital of Fudan University.Results(1)PMV related settings:Nine out of eleven hospitals had established PMV multidisciplinary teams,respiratory techniques such as diaphragm ultrasound and airway peak flow monitoring could be respectively executed in 72.7%and 36.4%of PICU.Pulmonary rehabilitation techniques such as airway clearance techniques,induced spirometer exercise,external diaphragm pacemaker stimulation,transfer bed exercise,balloon blowing,hyperbaric oxygen therapy could be respectively executed in 100.0%,9.1%,9.1%,9.1%,27.3%and 27.3%of PICU,respectively.(2)The cognitive status quo of children′s PMV:The most medical staffs agreed with the view that PMV referred to the children′s continuous mechanical ventilation for more than two weeks.Sixty percent of medical staffs believed that children with PMV had basic central nervous system diseases,and 62.7%of medical staffs believed that the most common causes of difficulty in PMV weaning was abnormal brain function.(3)The cognitive status quo of the children′s PMV management in PICU:Respondents believed that the most commonly used mechanical ventilation mode was synchronized intermittent mandatory ventilation+pressure support ventilation in children′s PMV during stable disease.Ninety-two percent of medical staffs performed the spontaneous breathing test when weaning.And 58.7%of the respondents agreed to perform tracheotomy for the children during 3 to 4 weeks of mechanical ventilation.More than half of medical staffs would execute diaphragm function assessment,bedside rehabilitation training,nutritional assessment,analgesia and sedation assessment for children with PMV.(4)The cognitive status quo of the children′s PMV management of transition from hospital to family:54.5%of PICU provided family care training to the family members before the children were discharged from the hospital.One center established the PMV specialized outpatient clinic.45.5%of PICU would follow up these discharged children one month later.Conclusion At present,PICU medical staffs have different awareness of children′s PMV related problems in China.And children′s PMV lacks a systematic plan regarding diagnosis,treatment and management.