Department of Pediatrics, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia.
Pediatr Crit Care Med. 2011 Jan;12(1):e7-13. doi: 10.1097/PCC.0b013e3181d505f4.
To determine the factors that predict outcome of noninvasive ventilation (NIV) in critically ill children.
Prospective observational study.
Multidisciplinary pediatric intensive care unit of a university hospital in Malaysia.
Patients admitted to the pediatric intensive care unit from July 2004 to December 2006 for respiratory support due to acute respiratory failure and those extubated from invasive mechanical ventilation.
NIV was used as an alternative means of respiratory support for all children. In patients who had prior invasive mechanical ventilation, NIV was used to facilitate extubation, or it was used after a failed extubation. The children were assigned to the nonresponders group (intubation was needed) or responders group (intubation was avoided totally or for at least 5 days). The physiologic variables were monitored before, at 6 hrs, and 24 hrs of NIV.
Of 278 patients, 129 were admissions for management of acute respiratory failure and 149 patients received NIV to facilitate extubation (n = 98) or for a failed extubation (n = 48). Their median age and weight were 8.7 months (interquartile range, 3.1-33.1 months) and 5.5 kg (interquartile range, 3.3-10.8 kg), respectively. Intubation was avoided for > 5 days in 79.1% (n = 220). No significant difference in age or weight of responders and nonresponders was observed. The cardiorespiratory variables in all patients improved, but significant differences between the two groups were noted at 6 hrs and 24 hrs after NIV.
NIV was a feasible strategy of respiratory support to avoid intubation in > 75% of children in this study. A higher Pediatric Risk of Mortality II score, sepsis at initiation of NIV, an abnormal respiratory rate, and a higher requirement of Fio2 may be predictive factors of NIV failure.
确定预测危重症儿童无创通气（NIV）结局的因素。
前瞻性观察研究。
马来西亚一所大学医院的多学科儿科重症监护病房。
2004 年 7 月至 2006 年 12 月期间，因急性呼吸衰竭收入儿科重症监护病房接受呼吸支持并接受有创机械通气脱机的患者。
所有患者均使用 NIV 作为呼吸支持的替代手段。对于先前有创机械通气的患者，使用 NIV 来辅助脱机，或在脱机失败后使用。将患者分为无反应组（需要插管）或有反应组（完全避免插管或至少 5 天不需要插管）。在开始 NIV 前、6 小时和 24 小时监测生理变量。
在 278 例患者中，129 例为急性呼吸衰竭的管理入院，149 例接受 NIV 以辅助脱机（n = 98）或因脱机失败（n = 48）。其平均年龄和体重分别为 8.7 个月（四分位间距 3.1-33.1 个月）和 5.5kg（四分位间距 3.3-10.8kg）。79.1%（n = 220）的患者 > 5 天无需插管。有反应者和无反应者的年龄或体重无显著差异。所有患者的心肺生理变量均有所改善，但在 NIV 后 6 小时和 24 小时两组间有显著差异。
在本研究中，NIV 是一种可行的呼吸支持策略，可使 > 75%的儿童避免插管。较高的儿科死亡率风险 II 评分、NIV 开始时的败血症、异常呼吸频率和更高的 Fio2 需求可能是 NIV 失败的预测因素。
