Hospital Clínico Universitario, Valencia, Spain.
Pediatr Crit Care Med. 2010 Nov;11(6):675-80. doi: 10.1097/PCC.0b013e3181d8e303.
To identify success and failure prognostic signs of noninvasive ventilation in pediatric acute respiratory failure. Noninvasive ventilation constitutes an alternative treatment for pediatric acute respiratory failure. However, tracheal intubation should not be delayed when considered necessary.
Prospective, noncontrolled, clinical study.
Pediatric intensive care unit in a university hospital.
Children (age range, 1 month-16 yrs) with moderate-to-severe acute respiratory failure who received noninvasive ventilation during a 4-year period. Failure was defined as the need for tracheal intubation.
None.
Nine (19.1%) of 47 patients needed tracheal intubation between the third and 87th hour after the start of treatment (33.6 ± 29.6 hrs). Failure was associated with the younger age group (4 ± 3.3 yrs vs. 7.7 ± 5 yrs, p < .04), acute respiratory distress syndrome (failure/acute respiratory distress syndrome: 5 of 10 vs. failure/non acute respiratory distress syndrome: 4 of 37, p = .013), and worsening radiographic images taken at 24 hrs and/or 48-72 hrs (p = .001 and p < .001, respectively). A significant reduction in heart rate was observed between the second and fourth hour after starting noninvasive ventilation (130 ± 25.8 bpm vs. 116 ± 27.7 bpm, p < .001) and Pco2 (54.1 ± 19.5 torr vs. 48.6 ± 14.3 torr; 7.21 ± 2.6 vs. 6.48 ± 1.91 kPa, p < .007) in the success group. The failure group had a higher rate of breathing assistance, both initial and maximal. In the multivariant analysis, only maximum mean airway pressure and Fio2 formed part of the success/failure discriminant function with a cutoff point of 11.5 and 0.57, respectively.
Modifications in a patient's respiratory assistance were made depending on the clinical, blood gas, and radiologic evolution of the patient. Mean airway pressure and Fio2 values of >11.5 and 0.6, respectively, predict failure and possibly set the limit above the patient's risk of delayed intubation increases.
确定小儿急性呼吸衰竭患者接受无创通气治疗成功和失败的预后指标。无创通气是小儿急性呼吸衰竭的一种替代治疗方法。但是，如果有必要，不应延迟气管插管。
前瞻性、非对照的临床研究。
大学医院儿科重症监护病房。
4 年间接受无创通气治疗的中重度急性呼吸衰竭患儿（年龄 1 个月-16 岁）。失败的定义为需要气管插管。
无。
9 例（19.1%）患者在治疗开始后第 3 至 87 小时（33.6 ± 29.6 小时）需要气管插管。失败与年龄较小（4 ± 3.3 岁与 7.7 ± 5 岁，p <.04）、急性呼吸窘迫综合征（失败/急性呼吸窘迫综合征：10 例中的 5 例与失败/非急性呼吸窘迫综合征：37 例中的 4 例，p =.013）和治疗后 24 小时和/或 48-72 小时影像学恶化（p =.001 和 p <.001）相关。与无创通气开始后的第 2 至第 4 小时相比，心率显著降低（130 ± 25.8 次/分与 116 ± 27.7 次/分，p <.001），pco2 降低（54.1 ± 19.5 torr 与 48.6 ± 14.3 torr；7.21 ± 2.6 与 6.48 ± 1.91 kPa，p <.007）。成功组的呼吸支持率在初始和最大时均较高。在多变量分析中，只有最大平均气道压力和 Fio2 是成功/失败判别函数的一部分，截断值分别为 11.5 和 0.57。
根据患者的临床、血气和影像学演变，对患者的呼吸支持进行了调整。平均气道压力和 Fio2 值分别>11.5 和 0.6，可预测失败，并可能使患者延迟插管风险增加的界限设定在更高水平。
