Mayordomo-Colunga J, Medina A, Rey C, Los Arcos M, Concha A, Menéndez S
Sección de Cuidados Intensivos Pediátricos, Hospital Universitario Central de Asturias, Oviedo, España.
An Pediatr (Barc). 2009 Jan;70(1):34-9. doi: 10.1016/j.anpedi.2008.09.003. Epub 2008 Dec 3.
The objective was to identify predictive factors for non-invasive ventilation (NIV) failure and to describe its use in bronchiolitis.
Prospective observational study that included patients diagnosed with bronchiolitis with a modified Wood's Clinical Asthma Score 5, or oxygen saturation <92%, or venous CO(2) partial pressure (PCO(2)) 60 mm Hg, with no response to medical treatment, who received NIV from December 2005 to May 2008. We collected clinical data before NIV began and at 1, 6, 12, 24 and 48 h. Need for intubation was considered as NIV failure.
NIV was successful in 83% of 47 cases included. Patients in whom NIV failed had lower weight (5.2+/-2.2 vs. 3.5+/-0.8 kg, P=.011), lower age [1.8 (0.3-12.3) vs. 0.8 (0.4-4.3) months, P=.038)], lower heart rate (HR) before NIV began (176.3+/-19.1 vs. 160.4+/-9.7 beats/minute, P=.010), lower HR decrease at hours 1 (-16.0+/-17.3 vs.+1.1+/-11.6, P=.005) and 12 (-31.5+/-19.7 vs. -0.75+/-12.2, P=.002), presence of apnoeas (23.1% vs. 75%; P=.004) and of a predisposing condition (84.6% vs. 50%; P=.029). Multivariate analysis identified the absence of a predisposing condition, and a greater HR decrease during the first hour as success-associated independent factors (OR 0.004; 95% CI 0.000-0.664 and OR 0.896; 95% CI: 0.809-0.993, respectively).
NIV has a high success rate in bronchiolitis. The main parameters which can predict NIV success are the absence of a predisposing condition and a higher HR decrease in the first hour.
目的是确定无创通气（NIV）失败的预测因素，并描述其在细支气管炎中的应用。
一项前瞻性观察性研究，纳入了2005年12月至2008年5月期间诊断为细支气管炎且改良伍德临床哮喘评分≥5分、或氧饱和度<92%、或静脉血二氧化碳分压（PCO₂）≥60 mmHg、且药物治疗无效并接受NIV的患者。我们在NIV开始前以及开始后1、6、12、24和48小时收集临床数据。需要插管被视为NIV失败。
纳入的47例患者中，83%的NIV治疗成功。NIV失败的患者体重较低（5.2±2.2 vs. 3.5±0.8 kg，P = 0.011）、年龄较小[1.8（0.3 - 12.3）vs. 0.8（0.4 - 4.3）个月，P = 0.038]、NIV开始前心率（HR）较低（176.3±19.1 vs. 160.4±9.7次/分钟，P = 0.010）、第1小时（-16.0±17.3 vs. +1.1±11.6，P = 0.005）和第12小时（-31.5±19.7 vs. -0.75±12.2，P = 0.002）HR下降幅度较小、存在呼吸暂停（23.1% vs. 75%；P = 0.004）以及存在易感因素（8
