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Title: [Survey on the prevalence of continuous blood purification in Chinese pediatric critical care].
Author: Yang X, Qian SY, Zhu YM, Xu X, Liu CF, Xu F, Ren XX, Wang Y, Zhang YC, Lu GP.
Journal: Zhonghua Er Ke Za Zhi; 2018 Feb 02; 56(2):128-133. PubMed ID: 29429201.
Abstract:
Objective: To investigate the current application status of continuous blood purification (CBP) technology and equipment in pediatric intensive care unit (PICU) in China. Methods: A cross-sectional survey was conducted to understand the current popularization of CBP technology and equipment, the management of CBP equipment and consumables, and the application of CBP in different diseases. A questionnaire named Application Status of Continuous Blood Purification Technology was applied. Children's hospitals and polyclinic hospitals with the pediatric qualification (pediatric emergency or critical care unit members of Chinese Medical Association and Chinese Medical Doctor Association) were selected. Results: From December 2016 to February 2017, 53 hospitals completed the questionnaire, including 7 in northeast, 6 in north China, 16 in east China, 9 in south China, 5 in central China, 4 in the northwest, and 6 in the southwest region. Continuous renal replacement therapy (CRRT), the most widely used technology, was carried out in 51 hospitals. Other technologies were peritoneal dialysis (IPD) (n=37), artificial liver support (ALSS) (n=26) and blood adsorption (PA) (n=13). There were 107 CBP machines in the 51 hospitals used CBP technology, with an average of 2.10/hospital. In 36 hospitals CBP machines were managed independently by PICU (70%). Hospitals made their own displacement liquid (n=40, 78%), or purchased displacement liquid (n=11, 22%). Hospitals prepared dialysate on their own (n=38, 75%), or purchased dialysate (n=13 hospitals, 25%). In 46 (90%) hospitals, hemodialysis catheter was placed independently by PICU doctors. The routine operation and maintenance of CBP were mainly completed by the PICU nurses in 36 hospitals (71%). There were 39 hospitals (76%) where professional nurses manage and maintain CBP. Puncture sites were femoral vein (n=26, 51%), internal jugular vein (n=21, 41%) and venae subclavia (n=4, 8%). Forty-two hospitals (82%) selected B-mode ultrasound positioning and guidance when performing internal jugular vein puncture. A total of 40 (78%) hospitals have developed post dilution and combined dilution techniques during the implementation of CBP. The most common indications of CBP technology were different in different regions. They were sepsis in northeast (24.0%, 243/1 011) and east China region (32.0%, 982/3 069), multiple organ dysfunction syndrome in south China (29.2%, 444/1 520), north China (15.8%, 126/796), and southwest region (30.1%, 460/1 526), drug poisoning in central China region (21.6%, 325/1 506), and renal failure in northwest region (53.0%, 44/83). Conclusions: CBP technology is widely used in the field of pediatric severe diseases in China. The eastern regions possess more CBP equipment than the western regions. CBP is widely used in the treatment of sepsis. 目的： 了解连续血液净化（CBP）技术及设备在儿童重症医学领域的应用现况。 方法： 采用横断面调查方案，选择55家儿童专科医院及有儿科资质的综合医院（中华医学会和中国医师协会儿科急救或重症学组成员单位）为调查对象，制定"CBP应用现状调查表"（简称调查表），对中国不同地区CBP技术及机器普及情况、CBP设备管理及相关耗材应用情况、CBP实施中相关技术开展情况及CBP在不同地区疾病的应用进行现况调查。 结果： 2016年12月至2017年2月，共发放55份调查问卷，最终收回53份，其中东北地区7家，华北地区6家、华东地区16家、华南地区9家、华中地区5家、西北地区4家、西南地区6家。连续肾脏替代治疗（CRRT）技术已开展医院最多（51家），其次为腹膜透析（IPD）技术（37家），人工肝支持（ALSS）及血液吸附（PA）技术开展较少，分别有26家及13家医院开展。51家开展CBP技术的医院共有107台CBP机器，平均2.10台/家，36家医院CBP机器由儿童重症监护室（PICU）独立管理（70%）。40家（78%）医院自行配制置换液，11家医院使用市售置换液（22%）；38家（75%）为自行配制透析液，13家（25%）医院使用市售透析液。46家（90%）医院均由PICU医生独立完成中心静脉置管。36家（71%）医院CBP日常的操作及维护多由PICU护士完成，其中39家医院（76%）配有管理及维护CBP的专业性护士。穿刺部位的选择：26家(51%)医院选择股静脉、21家(41%)选择颈内静脉及4家(8%)选择锁骨下静脉，42家（82%）医院在颈内静脉穿刺的时候选择B超定位及引导。40家（78%）医院在CBP实施过程中已开展了后稀释或前后稀释联合技术。各地区应用CBP最主要的适应证不同，东北（24.0%，243/1 011）、华东（32.0%，982/3 069）地区为脓毒症，华南（29.2%，444/1 520）、华北（15.8%，126/796）、西南（30.1%，460/1 526）地区为多脏器功能衰竭综合征（MODS）；华中地区为药物中毒（21.6%，325/1 506），西北地区为肾功能衰竭（53.0%，44/83）。 结论： CBP技术在全国儿童重症领域快速推广；CBP机器东部地区较西部地区保有量高；CBP广泛应用于脓毒症的治疗。.

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