Carroll Christopher L, Zucker Aaron R
Department of Pediatrics, Connecticut Children's Medical Center, Hartford, Connecticut, USA.
J Asthma. 2008 Jun;45(5):421-4. doi: 10.1080/02770900802085451.
Children with impending respiratory failure due to severe asthma may be treated with endotracheal intubation and mechanical ventilation. Barotrauma occurs in a significant number of these children. Non-invasive positive pressure ventilation (NPPV) has been used as an alternative intermediary therapy and potentially prevents intubation. However, the comparative risk of barotrauma associated with the use of NPPV has not been evaluated in this population.
To determine if the mode of positive pressure delivery per se affects the likelihood of development of barotrauma.
We retrospectively examined data from all children older than 2 years of age admitted to the Intensive Care Unit (ICU) with an asthma exacerbation between April 1997 and August 2006.
Of the 293 children admitted to the ICU with asthma, 45 (17%) received treatment with positive pressure ventilation: 11 received only NPPV, 29 were intubated and mechanically ventilated, and 7 children received both of these therapies. Compared with those not requiring positive pressure, children receiving positive pressure were significantly more likely to develop barotrauma during hospitalization (OR 8.9; 95% CI 2.4-32.7). However, the incidence of barotrauma did not significantly differ according to the mode of positive pressure delivery: 9% in those who received only NPPV, 14% in those who were intubated, and 14% in those who received both therapies (p = 0.92).
The use of positive pressure is associated with an increased risk of barotrauma in children with asthma, regardless of the mode of delivery.
因严重哮喘而濒临呼吸衰竭的儿童可能会接受气管插管和机械通气治疗。这些儿童中有相当一部分会发生气压伤。无创正压通气（NPPV）已被用作一种替代的中间治疗方法，并有可能避免插管。然而，在这一人群中，与使用NPPV相关的气压伤比较风险尚未得到评估。
确定正压通气的方式本身是否会影响气压伤发生的可能性。
我们回顾性研究了1997年4月至2006年8月期间因哮喘加重入住重症监护病房（ICU）的所有2岁以上儿童的数据。
在293名因哮喘入住ICU的儿童中，45名（17%）接受了正压通气治疗：11名仅接受NPPV治疗，29名进行了插管和机械通气，7名儿童接受了这两种治疗。与那些不需要正压通气的儿童相比，接受正压通气的儿童在住院期间发生气压伤的可能性显著更高（比值比8.9；95%置信区间2.4 - 32.7）。然而，根据正压通气的方式，气压伤的发生率没有显著差异：仅接受NPPV治疗的儿童中为9%，插管儿童中为14%，接受两种治疗的儿童中为14%（p = 0.92）。
对于哮喘儿童，无论采用何种通气方式，使用正压通气都与气压伤风险增加相关。
