O'Brien Jane E, Dumas Helene M, Haley Stephen M, O'Neil Margaret E, Renn Margaret, Bartolacci Teresa E, Kharasch Virginia
The Research Center for Children with Special Health Care Needs, Franciscan Children's Hospital and Rehabilitation Center, Boston, MA 02135, USA.
Clin Pediatr (Phila). 2002 Apr;41(3):155-62. doi: 10.1177/000992280204100305.
Medical records were reviewed to describe characteristics, report clinical and resource measures, and determine if differences exist between the diagnostic groups of prematurity and multiple congenital anomalies/neurologic conditions for initial admissions of 37 infants and toddlers to an inpatient pulmonary rehabilitation program. More than 75% of the children had a tracheostomy at admission and discharge. Forty-six percent of the sample was admitted requiring only oxygen, whereas 51% were discharged requiring only oxygen and not mechanical ventilation. Thirty percent of the children weaned to a less invasive mode of ventilation while just under half of the children were discharged home. Between-group comparisons indicated statistically significant differences for nutritional support at discharge (p < or = 0.05) and discharge disposition (p = 0.04). Complete weaning of oxygen or ventilator support during an initial inpatient pulmonary rehabilitation admission occurred less frequently than weaning to a less invasive mode of ventilation. This is an important consideration for referring children to rehabilitation programs, for clinical program improvement activities, and for setting realistic expectations for referral sources, patients and families, clinical staff, and payers. Further study is recommended using clinical data in program planning, in program improvements, and for setting outcome expectations for infants and toddlers dependent on pulmonary technology.
回顾医疗记录以描述特征、报告临床和资源指标，并确定37名婴幼儿首次入住住院肺部康复项目时，早产与多发先天性异常/神经疾病诊断组之间是否存在差异。超过75%的儿童在入院和出院时进行了气管切开术。样本中有46%的儿童入院时仅需吸氧，而51%的儿童出院时仅需吸氧且无需机械通气。30%的儿童成功撤机至侵入性较小的通气模式，近一半的儿童出院回家。组间比较显示，出院时的营养支持（p≤0.05）和出院处置（p = 0.04）存在统计学显著差异。在首次住院肺部康复期间，完全撤机或停氧的情况比撤机至侵入性较小的通气模式更为少见。这对于将儿童转介至康复项目、临床项目改进活动以及为转介来源、患者及其家庭、临床工作人员和付款方设定现实期望而言是一个重要考量因素。建议在项目规划、项目改进以及为依赖肺部技术的婴幼儿设定预后期望时，进一步利用临床数据开展研究。
