Paediatric Intensive Care Unit, Great Ormond Street Hospital for Children, Great Ormond Street, WC1N 3JH, London, UK.
Intensive Care Med. 2011 Dec;37(12):1994-2001. doi: 10.1007/s00134-011-2386-y. Epub 2011 Oct 8.
To determine whether physiological parameters and underlying condition can be used to predict which patients can be managed successfully on non-invasive ventilation (NIV).
Review of case notes and computerised data of every paediatric intensive care unit (PICU) admission over 7 years where NIV was commenced. Data immediately prior to commencing NIV and 2 h after its establishment was collected. Univariable and multivariable statistical analysis was performed to compare variables.
Eighty-three patients commenced NIV attempting to avoid intubation and 64% succeeded. Those who failed required a higher FiO2 (0.56 vs. 0.47, p = 0.038), had higher respiratory rates (53.3 vs. 40.3 breaths/min, p = 0.012) and lower pH (7.26 vs. 7.34, p = 0.032) before NIV and higher FiO2 after NIV commenced (0.54 vs. 0.43, p = 0.009). Those with a respiratory diagnosis were more likely to be successful. Patients with oncologic disease, particularly if septic, were less likely to avoid intubation using NIV. Multivariable models showed that after adjustment for mode of NIV and underlying diagnosis, respiratory rate before NIV was an independent predictor of success [adjusted odds ratio (OR) 0.95 (0.91, 0.99), p = 0.01]. Eighty patients were extubated to NIV but 15 required re-intubation. Those re-intubated had a higher systolic blood pressure (104 vs. 77.9 mmHg, p = 0.001) and diastolic blood pressure (64.5 vs. 54.1 mmHg, p = 0.0037) after extubation. Multivariable models showed that systolic blood pressure 2 h after extubation was independently associated with outcome [adjusted OR 0.96 (0.93, 0.99), p = 0.007].
Parameters relating to respiratory and cardiovascular status can determine which patients will successfully avoid intubation or re-intubation when placed on NIV. Underlying disease and reason for admission should be considered when predicting the outcome of NIV.
确定生理参数和基础状况是否可用于预测哪些患者可以成功接受无创通气（NIV）治疗。
回顾 7 年来每个儿科重症监护病房（PICU）中开始使用 NIV 的病例记录和计算机数据。收集开始使用 NIV 前和建立后 2 小时的即时数据。对变量进行单变量和多变量统计分析。
83 例患者开始使用 NIV 以避免插管，其中 64%成功。失败的患者需要更高的 FiO2（0.56 比 0.47，p=0.038）、更高的呼吸频率（53.3 比 40.3 次/分钟，p=0.012）和更低的 pH 值（7.26 比 7.34，p=0.032），且在开始使用 NIV 后 FiO2 更高（0.54 比 0.43，p=0.009）。有呼吸系统诊断的患者更有可能成功。患有肿瘤疾病的患者，特别是感染性疾病的患者，使用 NIV 避免插管的可能性较小。多变量模型显示，在调整 NIV 模式和基础诊断后，NIV 前的呼吸频率是成功的独立预测因素[调整后的优势比（OR）0.95（0.91，0.99），p=0.01]。80 例患者从插管转为 NIV，但 15 例需要重新插管。重新插管的患者拔管后收缩压（104 比 77.9mmHg，p=0.001）和舒张压（64.5 比 54.1mmHg，p=0.0037）更高。多变量模型显示，拔管后 2 小时的收缩压与结果独立相关[调整后的 OR 0.96（0.93，0.99），p=0.007]。
与呼吸和心血管状态相关的参数可以确定哪些患者在接受 NIV 治疗时可以成功避免插管或重新插管。在预测 NIV 结果时，应考虑基础疾病和入院原因。
