Kline-Krammes Sarah, Reed Christina, Giuliano John S, Schwartz Hamilton P, Forbes Michael, Pope John, Besunder James, Gothard Michael D, Russell Kerry, Bigham Michael T
Department of Pediatrics, Division of Emergency Medicine, Akron Children's Hospital, OH, USA.
Air Med J. 2012 May-Jun;31(3):131-7. doi: 10.1016/j.amj.2011.08.004.
Upper airway obstruction is responsive to the reduction in airflow turbulence provided by helium/oxygen (heliox) admixture. Our pediatric critical care transport team (PCCTT) has used heliox for children with upper airway obstruction from croup. We sought to describe our experience with heliox on transport and hypothesized that heliox-treated children with croup would show a more rapid clinical improvement.
Children with croup transported by our PCCTT and admitted to the PICU were evaluated. We analyzed pretransport care, transport interventions, and outcomes. Croup scores (Modified Taussig) were assigned retrospectively according to respiratory therapy charting. Data were analyzed using appropriate statistical tests, including Pearson's chi-square test, Fisher's exact test, Mann-Whitney U rank comparison, and two-sample t-test.
Thirty-five children met inclusion criteria. Demographics were similar between groups. The pretransport medical care was similar between groups. Children receiving heliox had a higher baseline croup score [mean (SD) = 5.7(2.3) vs no heliox 2.9 (2.0), P < 0.001]. The improvement in croup scores over the first 60 minutes of transport was more rapid in the heliox-treated children (P < 0.001). There was no difference in the number of children requiring additional nebulized racemic epinephrine during transport. The PICU length of stay (P = 0.59) and hospital length of stay (P = 0.64) were similar between groups.
Heliox added to standard transport treatment for critically ill children with croup provides a more rapid improvement in croup scores. Heliox for croup during transport does not prolong intensive care unit stay. A prospective clinical trial is warranted to evaluate heliox in pediatric transport.
上气道梗阻对氦氧混合气（氦氧）所产生的气流湍流减少有反应。我们的儿科重症监护转运团队（PCCTT）已将氦氧用于患有喉炎导致上气道梗阻的儿童。我们试图描述我们在转运过程中使用氦氧的经验，并假设接受氦氧治疗的喉炎患儿临床改善会更快。
对由我们的PCCTT转运并入住儿科重症监护病房（PICU）的喉炎患儿进行评估。我们分析了转运前护理、转运干预措施及结果。根据呼吸治疗记录回顾性地分配喉炎评分（改良陶西格评分）。使用适当的统计检验进行数据分析，包括Pearson卡方检验、Fisher精确检验、Mann-Whitney U秩和比较以及两样本t检验。
35名儿童符合纳入标准。两组之间的人口统计学特征相似。两组之间的转运前医疗护理相似。接受氦氧治疗的儿童基线喉炎评分更高[均值（标准差）=5.7（2.3），未使用氦氧组为2.9（2.0），P<0.001]。在转运的前60分钟内，接受氦氧治疗的儿童喉炎评分改善更快（P<0.001）。转运期间需要额外雾化吸入消旋肾上腺素的儿童数量没有差异。两组之间在PICU住院时间（P=0.59）和住院总时间（P=0.64）方面相似。
在患有喉炎的危重症儿童的标准转运治疗中添加氦氧可使喉炎评分更快改善。转运期间使用氦氧治疗喉炎不会延长重症监护病房住院时间。有必要进行一项前瞻性临床试验来评估氦氧在儿科转运中的作用。
