Department of Pediatrics, Southern Illinois University School of Medicine, Springfield, IL, USA.
Pediatr Crit Care Med. 2012 Jul;13(4):393-8. doi: 10.1097/PCC.0b013e318238b07a.
Although noninvasive positive pressure ventilation is increasingly used for respiratory distress, there is not much data supporting its use in children with status asthmaticus. The objective of this study was to determine safety, tolerability, and efficacy of early initiation of noninvasive positive pressure ventilation in addition to standard of care in the management of children admitted with status asthmaticus.
A prospective, randomized, controlled, clinical trial.
Twenty patients (1-18 yrs old) admitted to the pediatric intensive care unit with status asthmaticus.
Children were randomized to receive either noninvasive positive pressure ventilation plus standard of care (noninvasive positive pressure ventilation group) or standard of care alone (standard group). Improvement in clinical asthma score was significantly greater in noninvasive positive pressure ventilation group compared to standard group at 2 hrs, 4-8 hrs, 12-16 hrs, and 24 hrs after initiation of interventions (p < .01). A significant decrease in respiratory rate at ≥ 24 hrs oxygen requirement after 2 hrs was noted in noninvasive positive pressure ventilation group as compared to standard group (p = .01 and p = .03, respectively). Although statistically not significant, fewer children in the noninvasive positive pressure ventilation group required adjunct therapy compared to standard group (11% vs. 50%; p = .07). There were no major adverse events related to noninvasive positive pressure ventilation. Nine out of ten patients tolerated noninvasive positive pressure ventilation through the duration of the study; noninvasive positive pressure ventilation had to be discontinued in one patient because of persistent cough.
Early initiation of noninvasive positive pressure ventilation, along with short acting β-agonists and systemic steroids, can be safe, well-tolerated, and effective in the management of children with status asthmaticus.
尽管无创正压通气在治疗呼吸窘迫方面的应用越来越多，但支持其在哮喘持续状态患儿中应用的数据并不多。本研究旨在确定在标准治疗的基础上，早期开始无创正压通气治疗儿童哮喘持续状态的安全性、耐受性和疗效。
前瞻性、随机、对照、临床试验。
20 例（1-18 岁）因哮喘持续状态入住儿科重症监护病房的患者。
患儿被随机分为接受无创正压通气加标准治疗（无创正压通气组）或单独标准治疗（标准组）。与标准组相比，干预后 2 小时、4-8 小时、12-16 小时和 24 小时，无创正压通气组的临床哮喘评分改善更为显著（p <.01）。与标准组相比，无创正压通气组在满足 24 小时吸氧需求后≥24 小时的呼吸频率显著下降（p =.01 和 p =.03）。与标准组相比，无创正压通气组需要辅助治疗的患儿较少（11%比 50%；p =.07），尽管这一差异无统计学意义。与无创正压通气相关的严重不良事件并不多。在研究期间，9/10 名患者能耐受无创正压通气；由于持续咳嗽，一名患者不得不停止无创正压通气。
在标准治疗的基础上，早期开始使用短效β-激动剂和全身皮质类固醇治疗儿童哮喘持续状态，可安全、耐受且有效。
