Department of Surgery and Research Institute, Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, OH, USA.
Pediatr Crit Care Med. 2013 Jan;14(1):e26-33. doi: 10.1097/PCC.0b013e31826e7254.
In children with respiratory failure secondary to pneumonia, extracorporeal life support can be lifesaving. Our goal was to identify variables associated with mortality in children with pneumonia requiring extracorporeal life support.
Data query and abstraction from a multicenter, international registry of extracorporeal life support, the Extracorporeal Life Support Organization Registry.
Extracorporeal Life Support Organization registry data from 1985 to 2010.
Patients ≤ 18 yr of age who received extracorporeal life support for respiratory failure secondary to pneumonia.
None.
Clinical variables, year of extracorporeal life support, and extracorporeal life support center location were collected. The primary outcome was survival at hospital discharge. Results are reported as predictive margins, which allow estimation of standardized mortality rates and differences for risk factors.
One thousand four hundred eighty-nine children were included. The median (interquartile range) age and duration of extracorporeal life support were 5.7 months (2.5-21.5) and 11 days (7-18). Arterial cannulation was performed in 65% of patients. Mortality was 39%. There was no relationship between mortality and age or pathogen. Duration of extracorporeal life support had a biphasic relationship on mortality; mortality decreased 1.3% per day on extracorporeal life support until 14 days and then increased by 1.8% per day thereafter. Other independent predictors of mortality (p < 0.05) were pre-extracorporeal life support factors including duration of mechanical ventilation, peak inspiratory pressure, arterial oxygen saturation, pH, cardiac arrest, need for an arterial cannula, decade of extracorporeal life support, international extracorporeal life support center, and decrease in FIO2 over the first 24 hrs on extracorporeal life support.
In children with severe pneumonia receiving extracorporeal life support, prognostic factors associated with increased risk of death included extracorporeal life support treatment exceeding 14 days, arterial cannulation, longer duration of mechanical ventilation, and decreased ability to wean ventilator FIO2 over the first 24 hrs on extracorporeal life support. Analysis of the Extracorporeal Life Support Organization registry can identify prognostic variables, which may influence medical decision making, resource utilization, and family counseling.
在因肺炎导致呼吸衰竭的儿童中，体外生命支持可以挽救生命。我们的目标是确定与需要体外生命支持的肺炎儿童死亡率相关的变量。
从多中心、国际性体外生命支持组织的体外生命支持登记处进行数据查询和提取。
体外生命支持组织登记处 1985 年至 2010 年的数据。
年龄≤18 岁，因肺炎导致呼吸衰竭接受体外生命支持的患者。
无。
收集了临床变量、体外生命支持年份和体外生命支持中心位置。主要结果是出院时的生存率。结果以预测范围报告，允许对危险因素进行标准化死亡率和差异的估计。
共纳入 1489 例患儿。中位（四分位间距）年龄和体外生命支持时间分别为 5.7 个月（2.5-21.5）和 11 天（7-18）。65%的患者进行了动脉插管。死亡率为 39%。死亡率与年龄或病原体之间没有关系。体外生命支持时间与死亡率呈双相关系；体外生命支持每天减少 1.3%，持续 14 天，此后每天增加 1.8%。死亡率的其他独立预测因素（p<0.05）包括体外生命支持前的因素，包括机械通气时间、吸气峰压、动脉血氧饱和度、pH 值、心搏骤停、需要动脉插管、体外生命支持的十年、国际体外生命支持中心以及体外生命支持的最初 24 小时内 FIO2 的下降。
在接受体外生命支持治疗的严重肺炎儿童中，与死亡风险增加相关的预后因素包括体外生命支持治疗超过 14 天、动脉插管、机械通气时间延长以及体外生命支持的最初 24 小时内呼吸机 FIO2 脱机能力下降。对体外生命支持组织登记处的分析可以确定预后变量，这可能影响医疗决策、资源利用和家庭咨询。
