背景:急性小儿哮喘的实践差异很大,特别是严重的恶化。尚不清楚这是否是由于临床指南的差异。
目的:描述和比较不同地理区域儿童哮喘急性发作临床指南的内容和质量。
方法:来自六个地区儿科急诊研究网络全球合作机构的急性儿科哮喘治疗指南的观察性研究。
结果:确定了158个指南。一半为至少两个年龄组提供了建议,大多数指南根据哮喘严重程度提供治疗建议.对于吸入性短效β受体激动剂和全身性皮质类固醇的使用有一致的建议。吸入抗胆碱能治疗被推荐在大多数指南的严重和严重的哮喘,但在轻度和中度加重中使用该药物的建议不一致.其他吸入疗法,如氦气-氧气混合物(Heliox)和雾化镁不一致地推荐用于严重和危重病。胃肠外支气管扩张剂治疗和肾上腺素主要用于严重和危重哮喘,用静脉注射镁最推荐。其他肠胃外支气管扩张剂的使用存在区域差异,尤其是氨茶碱。指南质量评估确定了高评级,以明确表示,范围和目的,但利益相关者参与的评级较低,发展的严谨性,适用性和编辑独立性。
结论:当前儿科急性哮喘急性发作治疗指南在重要质量领域存在严重缺陷,对严重发作提供的指导有限且不一致。
BACKGROUND: There is significant practice variation in acute paediatric asthma, particularly severe exacerbations. It is unknown whether this is due to differences in clinical
guidelines.
OBJECTIVE: To describe and compare the content and quality of clinical
guidelines for the management of acute exacerbations of asthma in children between geographic regions.
METHODS: Observational study of
guidelines for the management of acute paediatric asthma from institutions across a global collaboration of six regional paediatric emergency research networks.
RESULTS: 158
guidelines were identified. Half provided recommendations for at least two age groups, and most guidelines provided treatment recommendations according to asthma severity.There were consistent recommendations for the use of inhaled short-acting beta-agonists and systemic corticosteroids. Inhaled anticholinergic therapy was recommended in most
guidelines for severe and critical asthma, but there were inconsistent recommendations for its use in mild and moderate exacerbations. Other inhaled therapies such as helium-oxygen mixture (Heliox) and nebulised magnesium were inconsistently recommended for severe and critical illness.Parenteral bronchodilator therapy and epinephrine were mostly reserved for severe and critical asthma, with intravenous magnesium most recommended. There were regional differences in the use of other parenteral bronchodilators, particularly aminophylline.Guideline quality assessment identified high ratings for clarity of presentation, scope and purpose, but low ratings for stakeholder involvement, rigour of development, applicability and editorial independence.
CONCLUSIONS: Current guidelines for the management of acute paediatric asthma exacerbations have substantial deficits in important quality domains and provide limited and inconsistent guidance for severe exacerbations.