Yañez Leticia J, Yunge Mauricio, Emilfork Marcos, Lapadula Michelangelo, Alcántara Alex, Fernández Carlos, Lozano Jaime, Contreras Mariana, Conto Luis, Arevalo Carlos, Gayan Alejandro, Hernández Flora, Pedraza Mariela, Feddersen Marion, Bejares Marcela, Morales Marta, Mallea Fernando, Glasinovic Maritza, Cavada Gabriel
University of Los Andes, Intensive Care Unit, Santa Maria Clinic, Los Andes, Chile [corrected].
Pediatr Crit Care Med. 2008 Sep;9(5):484-9. doi: 10.1097/PCC.0b013e318184989f.
To compare the benefits of noninvasive ventilation (NIV) plus standard therapy vs. standard therapy alone in children with acute respiratory failure; assess method effectiveness in improving gas exchange and vital signs; and assess method safety.
Prospective, randomized, controlled study. SITE: Two pediatric intensive care units in Santiago, Chile, at Clínica Santa María and Clínica Dávila, respectively.
Fifty patients with acute respiratory failure admitted to pediatric intensive care units were recruited; 25 patients were randomly allocated to noninvasive inspiratory positive airway pressure and expiratory positive airway pressure plus standard therapy (study group); the remaining 25 were given standard therapy (control group). Both groups were comparable in demographic terms.
The study group received NIV under inspiratory positive airway pressure ranging between 12 cm and 18 cm H2O and expiratory positive airway pressure between 6 cm and 12 cm H2O. Vital signs (cardiac and respiratory frequency), Po2, Pco2, pH, and Po2/Fio2 were recorded at the start and 1, 6, 12, 24, and 48 hrs into the study.
Heart rate and respiratory rate improved significantly with NIV. Heart rate and respiratory rate were significantly lower after 1 hr of treatment compared with admission (p = 0.0009 and p = 0.004, respectively). The trend continued over time, heart rate being significantly lower than control after the first hour and heart rate after 6 hrs. With NIV, Po2/Fio2 improved significantly from the first hour. The endotracheal intubation was significantly lower (28%) in the NIV group than in the control group (60%; p = 0.045).
NIV improves hypoxemia and the signs and symptoms of acute respiratory failure. NIV seems to afford these patients protection from endotracheal intubation.
比较无创通气（NIV）联合标准治疗与单纯标准治疗对急性呼吸衰竭患儿的疗效；评估该方法在改善气体交换和生命体征方面的有效性；并评估该方法的安全性。
前瞻性、随机、对照研究。
分别位于智利圣地亚哥圣玛丽亚诊所和达维拉诊所的两个儿科重症监护病房。
招募50名入住儿科重症监护病房的急性呼吸衰竭患者；25名患者被随机分配至无创吸气正压通气和呼气正压通气联合标准治疗组（研究组）；其余25名给予标准治疗（对照组）。两组在人口统计学方面具有可比性。
研究组在吸气正压12 cm至18 cm H₂O和呼气正压6 cm至12 cm H₂O下接受无创通气。在研究开始时以及开始后1、6、12、24和48小时记录生命体征（心率和呼吸频率）、动脉血氧分压（Po₂）、二氧化碳分压（Pco₂）、pH值以及氧合指数（Po₂/Fio₂）。
无创通气使心率和呼吸频率显著改善。治疗1小时后心率和呼吸频率与入院时相比显著降低（分别为p = 0.0009和p = 0.004）。这种趋势随时间持续，第1小时后心率显著低于对照组，6小时后的心率也是如此。采用无创通气后，从第1小时起氧合指数显著改善。无创通气组气管插管率显著低于对照组（28% 比60%；p = 0.045）。
无创通气可改善低氧血症及急性呼吸衰竭的体征和症状。无创通气似乎能使这些患者避免气管插管。
