Paediatric Intensive Care Unit, Department of Anaesthesiology and Intensive Care University Hospital A. Gemelli, Catholic University of the Sacred Heart, L.go A. Gemelli 8, 00168 Rome, Italy.
Intensive Care Med. 2011 Sep;37(9):1510-6. doi: 10.1007/s00134-011-2308-z. Epub 2011 Jul 14.
Non-invasive positive pressure ventilation (NIV) is being increasingly used in paediatric critical care, although its use in acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) is still debated. No definite data are available for the prediction of NIV outcome in such selected populations. We aimed to identify which factors might affect NIV failure in paediatric ALI/ARDS patients.
A retrospective cohort study using comprehensive predictivity analysis was performed. All children admitted to our paediatric intensive care unit over a 4-year period for ALI/ARDS were reviewed. Basic, clinical, physiological parameters and their change after 1 h of NIV were considered and subjected to univariate analysis. Candidate prognostic variables were then subjected to multicollinearity scrutiny and logistic regression. Finally, variables significant in the logistic regression were subjected to predictivity analysis.
The number of organ failures at admission (NOF) is a strong predictor of NIV failure (odds ratio 5.26; p = 0.004). Having only one organ failure provides a probability of NIV success of 85.7% (sensitivity 87%; specificity 49%). One NIV failure will be predicted and avoided for every four cases in which the presence of other organ failures is incorporated into the clinical decision.
NOF significantly predicts the NIV failure. Children with no organ failures other than ALI/ARDS may safely be treated with NIV.
尽管无创正压通气（NIV）在儿科重症监护中越来越多地被使用，但在急性肺损伤（ALI）和急性呼吸窘迫综合征（ARDS）中的使用仍存在争议。对于这些选定人群，尚无关于 NIV 结果预测的明确数据。我们旨在确定哪些因素可能会影响儿科 ALI/ARDS 患者的 NIV 失败。
使用全面预测性分析进行了回顾性队列研究。对我院儿科重症监护病房在 4 年内因 ALI/ARDS 住院的所有儿童进行了回顾。考虑了基本、临床、生理参数及其在 NIV 后 1 小时的变化，并进行了单因素分析。然后对候选预后变量进行多重共线性检查和逻辑回归。最后，对逻辑回归中具有统计学意义的变量进行预测性分析。
入院时器官衰竭的数量（NOF）是 NIV 失败的强有力预测因子（比值比 5.26；p = 0.004）。只有一个器官衰竭时，NIV 成功的概率为 85.7%（敏感性 87%；特异性 49%）。在将其他器官衰竭纳入临床决策的情况下，每出现 4 例 NIV 失败，就可以预测并避免 1 例失败。
NOF 显著预测了 NIV 失败。除 ALI/ARDS 外无其他器官衰竭的儿童可以安全地接受 NIV 治疗。
