Department of Pediatrics, Oulu University Hospital, Oulu, Finland.
Acta Paediatr. 2013 Feb;102(2):123-8. doi: 10.1111/j.1651-2227.2012.02830.x. Epub 2012 Sep 24.
To assess daily practices in paediatric and neonatal ventilatory care in Finland.
All neonatal and paediatric intensive care units in Finland were sent a questionnaire on ventilatory strategies and were offered a 3-month prospective survey.
A total of 96% of units returned the questionnaire, and clinicians agreed on most of the principles of lung-protective ventilation. Seventeen hospitals (94%) joined the prospective survey. On average, 2.3 new ventilation episodes were started daily, and totally 211 episodes were monitored. Pulmonary problems (64%) were the main cause of treatment in neonates and postoperative care (68%) in older children. Synchronized intermittent mandatory ventilation with pressure support was the primary mode in 42% of episodes. Hypocapnia was observed repeatedly in all units. In adult intensive care units, children often received high oxygen fraction, leading to hyperoxia, and they were frequently sedated with propofol, which is not licensed for that purpose. A large proportion of children had only light sedation or no sedation at all. Despite the different strategies and practices, most episodes resulted in a favourable outcome.
Most of the principles of lung-protective ventilation have been well accepted by clinicians. More attention should be paid to achieving normocapnia and normoxia and to the correct use of sedatives, especially in units that only occasionally provide paediatric ventilation.
评估芬兰儿科和新生儿通气治疗的日常实践。
芬兰所有新生儿和儿科重症监护病房都收到了一份关于通气策略的问卷，并提供了为期 3 个月的前瞻性调查。
共有 96%的单位返回了问卷，临床医生对大多数肺保护通气原则达成了一致。17 家医院（94%）参加了前瞻性调查。平均每天开始 2.3 例新的通气，共监测了 211 例。肺部问题（64%）是新生儿治疗的主要原因，大孩子则是术后护理（68%）。压力支持同步间歇指令通气是 42%的通气中的主要模式。所有单位都反复出现低碳酸血症。在成人重症监护病房，儿童经常接受高氧分数，导致氧中毒，并且经常使用丙泊酚镇静，而丙泊酚没有为此目的的许可。很大一部分儿童只有轻度镇静或根本没有镇静。尽管策略和实践不同，但大多数病例的结果都很好。
大多数肺保护通气原则已被临床医生广泛接受。应更加注意实现正常碳酸血症和正常氧合，以及正确使用镇静剂，尤其是在偶尔提供儿科通气的单位。
