Mathur N B, Garg Pankaj, Mishra T K
Department of Pediatrics, Maulana Azad Medical College, New Delhi 110 002, India.
Indian Pediatr. 2005 Jul;42(7):645-51.
To evaluate initial arterial blood gas, pulmonary pressures, pulmonary mechanics (compliance and resistance), pulmonary volumes, oxygenation indices and serum carotenoid levels as predictors of fatality in mechanically ventilated neonates.
Cross Sectional.
Referral neonatal unit of a teaching hospital.
83 mechanically ventilated outborn neonates.
83 neonates consecutively put on mechanical ventilator from March to December 2001 were enrolled in the study. The mechanical ventilator used was pressure limited time cycled ventilator with facility for online measurement of volumes and pulmonary mechanics. Arterial blood gas after half an hour of initiation of mechanical ventilation and initial pulmonary pressures, pulmonary compliance, resistance and duration of mechanical ventilation were recorded in a pre structured proforma. Initial serum carotenoid levels were also measured using spectrophotometric method. The neonates were regularly followed up for outcome. Multiple logistic regression analysis was done to find out the predictors of fatality for those variables that were significantly associated with outcome on univariate analysis.
On univariate analysis weight ( < 2000 g), gestational age <34 weeks, pH <7.3, duration of mechanical ventilation <72 hours, a/A <0.25, compliance <1 mL/cmH2O, fraction of inspired oxygen (FiO2) >60%, oxygenation index >10, AaDO2 >250 and serum carotenoid levels < 100 microg/dL were significantly associated with fatality in neonates requiring mechanical ventilation. However, on multiple regression analysis only FiO2, gestational age and serum carotenoids < 100 microg/dL were found to be independent predictors of fatality.
Initial FiO2 > 60%, gestational age <34 weeks and initial serum carotenoid levels < 100 microg/dL were independent predictors of fatality in neonatal mechanical ventilation. Even in a setting with high fatality rates, high risk of mortality in mechanically ventilated neonates can be identified.
评估初始动脉血气、肺压力、肺力学（顺应性和阻力）、肺容积、氧合指数及血清类胡萝卜素水平，以预测机械通气新生儿的死亡率。
横断面研究。
一家教学医院的新生儿转诊病房。
83例接受机械通气的外院出生新生儿。
选取2001年3月至12月期间连续接受机械通气的83例新生儿纳入研究。所用机械通气机为压力限制时间切换型通气机，具备在线测量容积和肺力学参数的功能。在预先设计的表格中记录机械通气开始半小时后的动脉血气以及初始肺压力、肺顺应性、阻力和机械通气时长。还采用分光光度法测量初始血清类胡萝卜素水平。对新生儿进行定期随访以了解结局。对单因素分析中与结局显著相关的变量进行多因素逻辑回归分析，以找出死亡的预测因素。
单因素分析显示，体重（<2000g）、胎龄<34周、pH<7.3、机械通气时长<72小时、a/A<0.25、顺应性<1mL/cmH₂O、吸入氧分数（FiO₂）>60%、氧合指数>10、肺泡 - 动脉血氧分压差（AaDO₂）>250以及血清类胡萝卜素水平<100μg/dL与需要机械通气的新生儿死亡率显著相关。然而，多因素回归分析发现，只有FiO₂、胎龄和血清类胡萝卜素水平<100μg/dL是死亡的独立预测因素。
初始FiO₂>60%、胎龄<34周和初始血清类胡萝卜素水平<100μg/dL是新生儿机械通气死亡的独立预测因素。即使在死亡率较高的情况下，也能识别出机械通气新生儿的高死亡风险。
