Nizarali Zahara, Cabral Marta, Silvestre Catarina, Abadesso Clara, Nunes Pedro, Loureiro Helena, Almeida Helena
Rev Bras Ter Intensiva. 2012 Dec;24(4):375-80. doi: 10.1590/s0103-507x2012000400014.
The present study focused on respiratory syncytial virus bronchiolitis with respiratory failure. The aim of the study was to determine whether noninvasive ventilation reduces the need for endotracheal intubation or slows the clinical progression of acute respiratory syncytial virus bronchiolitis by reducing the incidence of infectious complications.
The present study was a retrospective cohort study. Cohort A was comprised of children who were admitted to the pediatric intensive and special care unit from 2003-2005 before starting noninvasive ventilation; cohort B was comprised of children who were admitted to the pediatric intensive and special care unit from 2006-2008 after starting noninvasive ventilation. With the exception of noninvasive ventilation, the therapeutic support was the same for the two groups. All children who were diagnosed with respiratory syncytial virus bronchiolitis and respiratory failure between November 2003 and March 2008 were included in the cohort. Demographic, clinical and blood gas variables were analyzed.
A total of 162 children were included; 75% of the subjects were less than 3 months old. Group A included 64 children, and group B included 98 children. In group B, 34 of the children required noninvasive ventilation. The distributions of the variables age, preterm birth, congenital heart disease, cerebral palsy and chronic lung disease were similar between the two groups. On admission, the data for blood gas analysis and the number of apneas were not significantly different between the groups. In group B, fewer children required invasive ventilation (group A: 12/64 versus group B: 7/98; p=0.02), and there was a reduction in the number of cases of bacterial pneumonia (group A: 19/64 versus group B: 12/98; p=0.008). There was no record of mortality in either of the groups.
By comparing children with the same disease both before and after noninvasive ventilation was used for ventilation support, we verified a reduction in infectious complications and cases requiring intubation.
本研究聚焦于呼吸道合胞病毒细支气管炎伴呼吸衰竭。该研究的目的是确定无创通气是否能减少气管插管的需求，或通过降低感染性并发症的发生率来减缓急性呼吸道合胞病毒细支气管炎的临床进展。
本研究为回顾性队列研究。队列A由2003年至2005年在开始无创通气之前入住儿科重症和特殊护理病房的儿童组成；队列B由2006年至2008年在开始无创通气之后入住儿科重症和特殊护理病房的儿童组成。除无创通气外，两组的治疗支持相同。2003年11月至2008年3月期间所有被诊断为呼吸道合胞病毒细支气管炎和呼吸衰竭的儿童均纳入该队列。对人口统计学、临床和血气变量进行了分析。
共纳入162名儿童；75%的受试者年龄小于3个月。A组有64名儿童，B组有98名儿童。在B组中，34名儿童需要无创通气。两组之间年龄、早产、先天性心脏病、脑瘫和慢性肺病等变量的分布相似。入院时，两组之间的血气分析数据和呼吸暂停次数无显著差异。在B组中，需要有创通气的儿童较少（A组：12/64 vs B组：7/98；p=0.02），细菌性肺炎病例数有所减少（A组：19/64 vs B组：12/98；p=0.008）。两组均无死亡记录。
通过比较在使用无创通气进行通气支持前后患有相同疾病的儿童，我们证实了感染性并发症和需要插管的病例有所减少。
