Piastra Marco, Antonelli Massimo, Chiaretti Antonio, Polidori Giancarlo, Polidori Lorenzo, Conti Giorgio
Pediatric Intensive Care Unit, Gemelli Policlinic, Catholic University Medical School, Largo Gemelli 8, 00168 Rome, Italy.
Intensive Care Med. 2004 Mar;30(3):472-6. doi: 10.1007/s00134-003-2103-6. Epub 2004 Jan 13.
To evaluate the feasibility of non-invasive ventilation (NIV) through a new interface-the helmet-in the treatment of acute respiratory failure (ARF) in hematologic children.
Observational, non-randomized report of four consecutive cases. Pediatric Intensive Care Unit in a university hospital.
Four consecutive females (aged 9-17 years) affected by acute leukemia (3 acute lymphocytic leukemia [ALL], 1 acute myeloid leukemia [AML]) and with hypoxemic ARF (defined by severe dyspnea at rest, respiratory rate >30 breaths/min, PaO2:FiO2 <200 and active contraction of the accessory muscles). Pressure support ventilation was delivered via a helmet (CaStar,Starmed, Italy) by means of an ICU ventilator (Servo 300, Siemens Elema, Sweden).
We evaluated the effect of pressure support ventilation delivered by helmet on blood gases, respiratory rate, hemodynamics, patient tolerance, complication rate and outcome. An improvement of oxygenation was uniformly observed within the first 3 h after admission. The helmet was well tolerated by all children. No complication was observed. Two patients were discharged from the PICU in stable clinical conditions, whereas the remaining two children overcame the respiratory distress but had non-respiratory complications and eventually died.
Non-invasive ventilation via the helmet can offer effective ventilatory support and improve gas exchange in the treatment of ARF in pediatric hematologic patients. As already shown in adults, NIV may decrease the risk of life-threatening complications associated with invasive mechanical ventilation (MV), also in children with hematologic malignancies; moreover, it offers the possibility of an earlier approach to respiratory failure in this patient subset.
评估通过一种新型接口——头盔进行无创通气（NIV）治疗血液系统疾病患儿急性呼吸衰竭（ARF）的可行性。
对连续4例病例的观察性、非随机报告。一所大学医院的儿科重症监护病房。
4例连续的女性患儿（年龄9 - 17岁），患有急性白血病（3例急性淋巴细胞白血病[ALL]，1例急性髓细胞白血病[AML]）且伴有低氧性ARF（定义为静息时严重呼吸困难、呼吸频率>30次/分钟、动脉血氧分压/吸入氧分数值[PaO2:FiO2]<200且辅助呼吸肌主动收缩）。通过头盔（CaStar，Starmed，意大利）借助重症监护病房呼吸机（Servo 300，西门子Elema，瑞典）给予压力支持通气。
我们评估了头盔给予的压力支持通气对血气、呼吸频率、血流动力学、患者耐受性、并发症发生率及转归的影响。入院后最初3小时内均观察到氧合改善。所有患儿对头盔耐受性良好。未观察到并发症。2例患儿在临床状况稳定时从儿科重症监护病房出院，而其余2例患儿克服了呼吸窘迫，但出现了非呼吸性并发症，最终死亡。
通过头盔进行无创通气可为儿科血液系统疾病患者ARF的治疗提供有效的通气支持并改善气体交换。正如在成人中已经显示出的，无创通气在血液系统恶性肿瘤患儿中也可能降低与有创机械通气（MV）相关的危及生命并发症的风险；此外，它为该患者亚组中更早地处理呼吸衰竭提供了可能性。
