Padman Raj, Henry Michael
Nemours Children's Clinic, Wilmington, Delaware, USA.
Del Med J. 2004 May;76(5):199-203.
To assess the outcome of bilevel positive airway pressure (BPAP) use for pediatric patients with sickle cell disease and acute chest syndrome.
Retrospective chart review of 25 occurrences of acute chest syndrome in nine children from 1994 to 2000.
A tertiary care children's hospital.
Seven boys and two girls (average age, 11.8 years; range, four to 20 years). Prior to admission, 80% had chest pain, 48% had back pain, 48% had extremity pain, 24% had fever, and 20% had cough.
Bilevel positive airway pressure therapy.
Patients' clinical values before and after BPAP were as follows: oxygen support (L), 4.1 +/- 3.2 and 1.4 +/- 1.7 (p < 0.001); oxygen saturation (%), 96.3 +/- 2.8 and 97.9 +/- 1.6 (p < 0.05); respiratory rate (per minute), 28.5 +/- 8.6 and 25.1 +/- 6.6 (p < 0.05); heart rate (per minute), 109 +/- 18 and 92 +/- 13 (p < 0.001). Patients' average highest intermittent positive airway pressure was 12 cm H2O, and the average highest expiratory positive airway pressure was 6 cm H2O. Patients spent an average of 3.1 days receiving BPAP. Of the patients, 4% suffered skin irritation over their nasal bridge, and 56% were admitted to the intensive care unit. The BPAP therapy was ineffective for only one patient. Most patients (96%) received BPAP in response to respiratory distress; 4% received it in response to increasing oxygen requirements after administration of narcotics and inability to perform incentive spirometry.
Data suggest that BPAP therapy can be used to improve oxygenation and decrease work of breathing among patients with acute chest syndrome. We believe that BPAP may prevent progression to acute hypoxic respiratory failure requiring intubation and ventilation. It may reduce costs, especially if intensive care unit admission can be avoided by beginning therapy early. This therapy may become a standard of care for children with acute chest syndrome. The study design (a retrospective chart review) was subject to limitations and bias. A multicenter, prospective, randomized trial is recommended.
评估双水平气道正压通气（BPAP）用于镰状细胞病和急性胸综合征患儿的疗效。
对1994年至2000年9名儿童中25次急性胸综合征发作情况进行回顾性病历审查。
一家三级护理儿童医院。
7名男孩和2名女孩（平均年龄11.8岁；范围4至20岁）。入院前，80%有胸痛，48%有背痛，48%有肢体疼痛，24%有发热，20%有咳嗽。
双水平气道正压通气治疗。
患者在接受BPAP治疗前后的临床指标如下：氧支持（升），4.1±3.2和1.4±1.7（p<0.001）；血氧饱和度（%），96.3±2.8和97.9±1.6（p<0.05）；呼吸频率（次/分钟），28.5±8.6和25.1±6.6（p<0.05）；心率（次/分钟），109±18和92±13（p<0.001）。患者的平均最高间歇气道正压为12 cmH₂O，平均最高呼气末气道正压为6 cmH₂O。患者接受BPAP治疗的平均时间为3.1天。患者中，4%鼻梁处出现皮肤刺激，56%入住重症监护病房。BPAP治疗仅对1例患者无效。大多数患者（96%）因呼吸窘迫接受BPAP治疗；4%因使用麻醉剂后氧需求增加且无法进行激励肺活量测定而接受治疗。
数据表明，BPAP治疗可用于改善急性胸综合征患者的氧合并减少呼吸功。我们认为，BPAP可能预防进展为需要插管和通气的急性低氧性呼吸衰竭。它可能降低成本，尤其是如果通过早期开始治疗可避免入住重症监护病房。这种治疗可能成为急性胸综合征患儿的标准治疗方法。本研究设计（回顾性病历审查）存在局限性和偏倚。建议进行多中心、前瞻性、随机试验。
