Pediatric Intensive Care Unit, Department of Anesthesia and Critical Care, IRCCS Fondazione Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milan, Italy.
Pediatr Crit Care Med. 2010 Jul;11(4):502-8. doi: 10.1097/PCC.0b013e3181b8063b.
To evaluate the feasibility and efficacy of continuous positive airway pressure delivered by a new pediatric helmet in comparison with a standard facial mask in infants with acute hypoxemic respiratory failure.
A single-center prospective case-control study.
Pediatric intensive care unit in a tertiary children hospital.
Twenty consecutive infants treated with continuous positive airway pressure by a helmet matched with a control patient treated with continuous positive airway pressure by facial mask and selected by age, weight, PaO2:Fio2, and PaCO2 on pediatric intensive care unit admission.
Feasibility was defined as the incidence of continuous positive airway pressure protocol failure secondary to 1) failure to administer continuous positive airway pressure because of intolerance to the interface; 2) deterioration in gas exchange soon after continuous positive airway pressure institution; and 3) major clinical adverse events such as pneumothorax or any hemodynamic instability related to the continuous positive airway pressure safety system device's failure. Evaluation of feasibility included also the total application time of respiratory treatment, the number of continuous positive airway pressure discontinuations/first 24 hrs. Interface-related complications included air leaks, cutaneous pressure sores, eye irritation, inhalation, and gastric distension. The 20 patients and control subjects had similar matching characteristics. Continuous positive airway pressure delivered by a helmet compared with a facial mask reduced continuous positive airway pressure trial failure rate (p = .02), increased application time (p = .001) with less discontinuations (p = .001), and was not associated with an increased rate of major adverse events, resulting in decreased air leaks (p = .04) and pressure sores (p = .002). Both continuous positive airway pressure systems resulted in early and sustained improvement in oxygenation.
The helmet might be considered a viable and safe alternative to a standard facial mask to deliver continuous positive airway pressure in hypoxemic infants in the pediatric intensive care unit setting. In our study, the helmet allowed more prolonged application of continuous positive airway pressure compared with a facial mask, ensuring similar improvement in oxygenation without any adverse events and clinical intolerance.
评估新型小儿头盔持续气道正压通气与标准面罩在急性低氧性呼吸衰竭婴儿中的应用的可行性和疗效。
单中心前瞻性病例对照研究。
三级儿童医院儿科重症监护病房。
连续 20 例接受头盔持续气道正压通气的婴儿与接受面罩持续气道正压通气的对照患者相匹配，并按年龄、体重、PaO2:Fio2 和入院时 PaCO2 进行选择。
可行性定义为以下原因导致持续气道正压通气方案失败的发生率：1）由于无法耐受接口而无法实施持续气道正压通气；2）在开始持续气道正压通气后不久气体交换恶化；3）气胸或与持续气道正压通气安全系统装置故障相关的任何血流动力学不稳定等主要临床不良事件。可行性评估还包括呼吸治疗的总应用时间、连续气道正压通气中断的次数/前 24 小时。与接口相关的并发症包括气漏、皮肤压疮、眼睛刺激、吸入和胃扩张。20 例患者和对照患者具有相似的匹配特征。与面罩相比，头盔提供的持续气道正压通气降低了持续气道正压通气试验失败率（p =.02），增加了应用时间（p =.001），中断次数减少（p =.001），且与主要不良事件发生率增加无关，导致气漏（p =.04）和压疮（p =.002）减少。两种持续气道正压通气系统均导致氧合的早期和持续改善。
在儿科重症监护病房环境中，头盔可被视为低氧血症婴儿提供持续气道正压通气的一种可行且安全的替代标准面罩的方法。在我们的研究中，与面罩相比，头盔允许更长时间地应用持续气道正压通气，在不发生任何不良事件和临床不耐受的情况下确保相似的氧合改善。
