将 PERT 引入儿科：儿科多学科肺栓塞反应小组（PERT）的初步经验和成果。

IF 9.5 1区医学 Q1 CRITICAL CARE MEDICINE

Chest Pub Date : 2024-10-03 DOI:10.1016/j.chest.2024.09.028

Mary P Dang, Anna Cheng, Jessica Garcia, Ying Lee, Mihir Parikh, Ali B V McMichael, Brian L Han, Sheena Pimpalwar, Elliot S Rinzler, Olivia L Hoffman, Sirine A Baltagi, Cindy Bowens, Abhay A Divekar, Paige Davis Volk, Craig J Huang, Surendranath R Veeram Reddy, Yousef Arar, Ayesha Zia

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引用次数: 0

摘要

导言：多学科肺栓塞反应小组（PERT）简化了对患有危及生命的肺栓塞（PE）的成人患者的治疗。鉴于小儿肺栓塞的罕见性，在儿科建立一个集临床、教育和研究为一体的肺栓塞应对小组模式是一个新颖且未得到充分利用的概念：研究设计和方法：研究设计和方法：为了获得机构的支持，我们制定了一项从战略到执行的提案，以启动儿科 PERT。主要利益相关者共同实施了 PERT。收集了PERT实施前和实施后两年的数据，并对结果进行了比较：结果：PERT 的实施历时 12 个月。我们的 PERT 由血液科牵头，由急诊科、重症监护科、介入心脏病科、麻醉科和介入放射科的儿科专家组成。我们分析了 30 名 PERT 前和 31 名 PERT 后患者的数据。PERT前，10%（3/30）、13%（4/30）、20%（6/30）和57%（17/30）的患者被归类为高风险 PE，PERT后，3%（1/31）、10%（3/31）、16%（5/31）和71%（22/31）的患者被归类为中低风险 PE、中高风险 PE 和低风险 PE。PERT后，有13例患者启动了PERT。所有符合条件的 PE 患者都启动了 PERT，另外还有 4 例低风险 PE 患者也启动了 PERT。PERT后做超声心动图的时间更短（4.7小时对2小时，P=0.0147）。PERT后的抗凝时间（90分钟 vs 54分钟，P=0.003）和给药时间（154分钟 vs 113分钟，P=0.049）更短。再灌注治疗的时间没有差异（PERT 前 12 小时 vs PERT 后 8.7 小时，P=0.1）。六名符合条件的（中高危和高危）患者中有五名（83.3%）在PERT后接受了再灌注治疗，而在PERT前的八名符合条件的患者中有三名（37.5%）接受了再灌注治疗（P=0.0001）。两个时代的大出血、死亡率或住院时间均无差异：儿科 PERT 范例在当地成功创建和采用。我们的 PERT 提高了专家的诊疗能力，促进了先进疗法的及时应用，并为低风险 PE 带来了价值。德克萨斯大学西南医学中心（UTSW）和德克萨斯儿童医疗系统的儿科 PERT 可作为简化儿科 PE 护理的最佳实践模式。

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Bringing PERT to Pediatrics: Initial Experience and Outcomes of a Pediatric Multidisciplinary Pulmonary Embolism Response Team (PERT).

Background: Multidisciplinary pulmonary embolism response teams (PERTs) streamline care of adults with life-threatening pulmonary embolism (PE). Given rarity of pediatric PE, developing a clinical, educational, and research PERT paradigm is a novel and underused concept in pediatrics.

Research question: Is a PERT feasible in pediatrics, and does it improve PE care?

Study design and methods: A strategy-to-execution proposal to launch a pediatric PERT was developed for institutional buy-in. Key stakeholders collectively implemented the PERT. Data were collected for the 2-year pre-PERT and post-PERT eras, and outcomes were compared.

Results: PERT implementation took 12 months. Our PERT, led by hematology, is composed of pediatric experts in emergency medicine, critical care, interventional cardiology, anesthesiology, and interventional radiology. Data on 30 patients pre-PERT and 31 patients post-PERT were analyzed. Pre-PERT, 10% (3 of 30), 13% (4 of 30), 20% (6 of 30), and 57% (17 of 30), and post-PERT, 3% (1 of 31), 10% (3 of 31), 16% (5 of 31), and 71% (22 of 31) were categorized as high-risk, intermediate-low-risk, intermediate-high-risk, and low-risk PE, respectively. Post-PERT, there were 13 unique PERT activations. PERT was activated on all eligible patients with PE and, additionally, on 4 low-risk PEs. Time to echocardiogram was shorter post-PERT (4.7 vs 2 hours, P = .0147). Anticoagulation was ordered (90 vs 54 minutes, P = .003) and given sooner (154 vs 113 minutes, P = .049) post-PERT. There were no differences in time to reperfusion therapies (12 hours pre-PERT vs 8.7 hours post-PERT, P = .10). Five of 6 (83.3%) eligible (intermediate-high and high-risk) patients received reperfusion therapies in the post-PERT era compared to 3 of 8 (37.5%) eligible patients in the pre-PERT era (P = .0001). There were no differences in major bleeding, mortality, or length of stay in either era.

Interpretation: The pediatric PERT paradigm was successfully created and adopted locally. Our PERT enhanced access to experts, facilitated timely advanced therapies, and held value for low-risk PE. The University of Texas Southwestern Medical Center and Children's Health System of Texas pediatric PERT may serve as a best practice model for streamlining care for pediatric PE.

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来源期刊

Chest 医学-呼吸系统

CiteScore

13.70

自引率

3.10%

发文量

3369

审稿时长

15 days

期刊介绍： At CHEST, our mission is to revolutionize patient care through the collaboration of multidisciplinary clinicians in the fields of pulmonary, critical care, and sleep medicine. We achieve this by publishing cutting-edge clinical research that addresses current challenges and brings forth future advancements. To enhance understanding in a rapidly evolving field, CHEST also features review articles, commentaries, and facilitates discussions on emerging controversies. We place great emphasis on scientific rigor, employing a rigorous peer review process, and ensuring all accepted content is published online within two weeks.