抗凝监测和目标:小儿体外膜氧合抗凝协作共识会议。

IF 4 2区 医学 Q1 CRITICAL CARE MEDICINE Pediatric Critical Care Medicine Pub Date : 2024-07-01 Epub Date: 2024-07-03 DOI:10.1097/PCC.0000000000003494
Caroline Ozment, Peta M A Alexander, Wayne Chandler, Sitaram Emani, Robert Hyslop, Paul Monagle, Jennifer A Muszynski, Ariane Willems, Alison Gehred, Elizabeth Lyman, Katherine Steffen, Ravi R Thiagarajan
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引用次数: 0

摘要

目标:就儿科体外膜肺氧合(ECMO)中的抗凝监测化验和目标水平达成系统性审查知情的改良德尔菲共识,供儿科 ECMO 抗凝协作组使用:数据来源:使用 PubMed、EMBASE 和 Cochrane Library (CENTRAL) 数据库对 1988 年 1 月至 2021 年 5 月期间的文献进行了结构化检索:ECMO儿科患者的抗凝监测:两位作者独立审阅所有引文,由第三位独立审阅者解决任何冲突。使用标准化数据提取表构建证据表:酌情使用预后研究质量工具或修订版 Cochrane 随机试验偏倚风险进行评估,并使用建议分级评估、发展和评价系统对证据进行评价。48 位专家历时 2 年召开会议,制定了以证据为基础的建议,并在缺乏证据的情况下,采用基于网络的改良德尔菲流程达成共识(定义为 > 80% 的一致意见),为临床建议制定了以专家为基础的共识声明,重点关注抗凝监测和目标。我们制定了一项弱建议、两项共识声明和三项良好实践声明,所有声明均达成了 80% 以上的一致意见。我们还获得了一些抗凝监测资源,供 ECMO 临床医师在床旁使用:结论:目前还没有足够的证据来制定儿科 ECMO 期间的最佳抗凝监测方法,但我们提出了一项建议、两项共识和三项良好实践声明。总体而言,现有的儿科证据并不充分,文献中也存在重大空白。
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Anticoagulation Monitoring and Targets: The Pediatric Extracorporeal Membrane Oxygenation Anticoagulation CollaborativE Consensus Conference.

Objectives: To derive systematic-review informed, modified Delphi consensus regarding anticoagulation monitoring assays and target levels in pediatric extracorporeal membrane oxygenation (ECMO) for the Pediatric ECMO Anticoagulation CollaborativE.

Data sources: A structured literature search was performed using PubMed, EMBASE, and Cochrane Library (CENTRAL) databases from January 1988 to May 2021.

Study selection: Anticoagulation monitoring of pediatric patients on ECMO.

Data extraction: Two authors reviewed all citations independently, with a third independent reviewer resolving any conflicts. Evidence tables were constructed using a standardized data extraction form.

Data synthesis: Risk of bias was assessed using the Quality in Prognosis Studies tool or the revised Cochrane risk of bias for randomized trials, as appropriate and the evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation system. Forty-eight experts met over 2 years to develop evidence-based recommendations and, when evidence was lacking, expert-based consensus statements for clinical recommendations focused on anticoagulation monitoring and targets, using a web-based modified Delphi process to build consensus (defined as > 80% agreement). One weak recommendation, two consensus statements, and three good practice statements were developed and, in all, agreement greater than 80% was reached. We also derived some resources for anticoagulation monitoring for ECMO clinician use at the bedside.

Conclusions: There is insufficient evidence to formulate optimal anticoagulation monitoring during pediatric ECMO, but we propose one recommendation, two consensus and three good practice statements. Overall, the available pediatric evidence is poor and significant gaps exist in the literature.

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来源期刊
Pediatric Critical Care Medicine
Pediatric Critical Care Medicine 医学-危重病医学
CiteScore
7.40
自引率
14.60%
发文量
991
审稿时长
3-8 weeks
期刊介绍: Pediatric Critical Care Medicine is written for the entire critical care team: pediatricians, neonatologists, respiratory therapists, nurses, and others who deal with pediatric patients who are critically ill or injured. International in scope, with editorial board members and contributors from around the world, the Journal includes a full range of scientific content, including clinical articles, scientific investigations, solicited reviews, and abstracts from pediatric critical care meetings. Additionally, the Journal includes abstracts of selected articles published in Chinese, French, Italian, Japanese, Portuguese, and Spanish translations - making news of advances in the field available to pediatric and neonatal intensive care practitioners worldwide.
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