Lowe Calvin G, Trautwein Johnn G
Division of Emergency and Transport Medicine, Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Eur J Pediatr. 2007 Oct;166(10):1025-31. doi: 10.1007/s00431-006-0374-y. Epub 2007 Jan 5.
Our aim was to determine whether starting inhaled nitric oxide (iNO) on critically ill neonates with severe hypoxemic respiratory failure and/or persistent pulmonary hypertension (PPH), at a referring hospital at the start of transport, decreases the need for extracorporeal membrane oxygenation (ECMO), lessens the number of hospital days and improves survival in comparison with those patients who were started on iNO only at the receiving facility. The study was a retrospective review of 94 charts of neonates that had iNO initiated by the transport team at a referring hospital or only at the tertiary neonatal intensive care unit (NICU) of the receiving hospital. Data collected included demographics, mode of transport, total number of hospital days, days on inhaled nitric oxide and ECMO use. Of the 94 patients, 88 were included. Of these, 60 were started on iNO at the referring facility (Field-iNO) and 28 were started at the receiving NICU (CHLA-iNO). All patients survived transport to the receiving NICU. Death rates and ECMO use were similar in both groups. Overall, patients who died were younger and had lower birth weights and Apgar scores. For all surviving patients who did not require ECMO, the length of total hospital stay (median days 22 versus 38, P = 0.018), and the length of the hospital stay at the receiving hospital (median days 18 versus 29, P = 0.006), were significantly shorter for the Field-iNO patients than for the CHLA-iNO patients, respectively. Earlier initiation of iNO may decrease length of hospital stay in surviving neonates with PPH not requiring ECMO.
我们的目的是确定在转运开始时，在转诊医院对患有严重低氧性呼吸衰竭和/或持续性肺动脉高压（PPH）的危重新生儿开始吸入一氧化氮（iNO），与仅在接收机构开始使用iNO的患者相比，是否能减少体外膜肺氧合（ECMO）的需求，减少住院天数并提高生存率。该研究是对94例新生儿病历的回顾性分析，这些新生儿在转诊医院或仅在接收医院的三级新生儿重症监护病房（NICU）由转运团队开始使用iNO。收集的数据包括人口统计学信息、转运方式、住院总天数、吸入一氧化氮的天数和ECMO的使用情况。94例患者中，88例被纳入研究。其中，60例在转诊机构开始使用iNO（现场-iNO组），28例在接收NICU开始使用iNO（儿童医院-iNO组）。所有患者均成功转运至接收NICU。两组的死亡率和ECMO使用率相似。总体而言，死亡患者年龄更小，出生体重和阿氏评分更低。对于所有存活且不需要ECMO的患者，现场-iNO组的住院总时长（中位数分别为22天和38天，P = 0.018）以及在接收医院的住院时长（中位数分别为18天和29天，P = 0.006）均显著短于儿童医院-iNO组。更早开始使用iNO可能会缩短患有PPH且不需要ECMO的存活新生儿的住院时长。
