Unidad de Cuidados Intensivos, Hospital de Niños Ricardo Gutiérrez, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina.
Pediatr Crit Care Med. 2011 Nov;12(6):e287-91. doi: 10.1097/PCC.0b013e3182191c0b.
To describe the characteristics and risk factors of pediatric patients who receive prolonged mechanical ventilation, defined as ventilatory support for >21 days.
Prospective cohort.
Four medical-surgical pediatric intensive care units in four university-affiliated hospitals in Argentina.
All consecutive patients from 1 month to 15 yrs old admitted to participating pediatric intensive care units from June 1, 2007, to August 31, 2007, who received mechanical ventilation (invasive or noninvasive) for >12 hrs.
None.
Demographic and physiologic data on admission to the pediatric intensive care units, drugs and events during the study period, and outcomes were prospectively recorded. A total of 256 patients were included. Of these, 23 (9%) required mechanical ventilation for >21 days and were assigned to the prolonged mechanical ventilation group. Patients requiring prolonged mechanical ventilation had higher mortality (43% vs. 21%, p < .05) and longer pediatric intensive care unit stay: 35 days [28-64 days] vs. 10 days [6-14]). There was no difference between the groups in age and gender distribution, reasons for admission, incidence of immunodeficiencies, or Paediatric Index of Mortality 2 score. The only difference at admission was a higher rate of genetic diseases in prolonged mechanical ventilation patients (26% vs. 9%, p < .05). There was a higher incidence of septic shock (87% vs. 34%, p < .01), acute respiratory distress syndrome (43% vs. 20%, p < .01), and ventilator-associated pneumonia (35% vs. 8%, p < .01) and higher utilization of dopamine (78% vs. 42%, p < .01), norepinephrine (61% vs. 15%, p < .01), multiple antibiotics (83% vs. 20%, p < .01), and blood transfusions (52% vs. 14%, p < .01). The proportion of extubation failure was higher in the prolonged mechanical ventilation group with similar rates of unplanned extubations in both groups. Variables remaining significantly associated with prolonged mechanical ventilation after multivariate analysis were treatment with multiple antibiotics, septic shock, ventilator-associated pneumonia, and use of norepinephrine.
Patients with prolonged mechanical ventilation have more complications and require more pediatric intensive care unit resources. Mortality in these patients duplicates that from those requiring shorter support.
描述接受长时间机械通气（定义为通气支持超过 21 天）的儿科患者的特征和危险因素。
前瞻性队列研究。
阿根廷四所大学附属医院的四个普通儿科重症监护病房。
2007 年 6 月 1 日至 8 月 31 日期间，所有连续入住参加儿科重症监护病房的年龄在 1 个月至 15 岁之间的患者，他们接受机械通气（有创或无创）超过 12 小时。
无。
前瞻性记录入住儿科重症监护病房时的人口统计学和生理学数据、研究期间的药物和事件以及结局。共纳入 256 例患者。其中 23 例（9%）需要机械通气超过 21 天，被分配到长时间机械通气组。需要长时间机械通气的患者死亡率更高（43%对 21%，p <.05），儿科重症监护病房停留时间更长：35 天[28-64 天]对 10 天[6-14 天]）。两组在年龄和性别分布、入院原因、免疫缺陷发生率或儿科死亡率 2 评分方面无差异。入院时唯一的区别是长时间机械通气患者的遗传疾病发生率较高（26%对 9%，p <.05）。败血症性休克发生率较高（87%对 34%，p <.01）、急性呼吸窘迫综合征（43%对 20%，p <.01）和呼吸机相关性肺炎（35%对 8%，p <.01），多巴胺使用率较高（78%对 42%，p <.01）、去甲肾上腺素（61%对 15%，p <.01）、多种抗生素（83%对 20%，p <.01）和输血（52%对 14%，p <.01）。长时间机械通气组的拔管失败比例较高，两组计划外拔管率相似。多变量分析后仍与长时间机械通气显著相关的变量为使用多种抗生素、败血症性休克、呼吸机相关性肺炎和使用去甲肾上腺素。
接受长时间机械通气的患者并发症更多，需要更多的儿科重症监护病房资源。这些患者的死亡率与需要较短支持的患者相同。
