波兰向新生儿无创通气转变的影响：一项人群研究。

Impact of the shift to neonatal noninvasive ventilation in Poland: a population study.

机构信息

1Department of Neonatology, The Medical Centre of Postgraduate Education, Warsaw, Poland. 2Department of Administration, Mountains Community Hospital, Lake Arrowhead, CA. 3Department of Neonatology, Medical University, Wroclaw, Poland. 4Department of Neonatology, The Voivodal Hospital, Olsztyn, Poland. 5Department of Neonatology, National Research Institute of Mother and Child, Warsaw, Poland. 6Department of Neonatology, Medical University of Warsaw, Warsaw, Poland. 7Department of Neonatology, University of Medical Sciences, Poznan, Poland. 8Department of Neonatology, Medical College Jagiellonian University of Krakow, Krakow, Poland. 9Department of Quantitative Methods and Information Systems, Warsaw School of Economics, Warsaw, Poland.

出版信息

Pediatr Crit Care Med. 2014 Feb;15(2):155-61. doi: 10.1097/PCC.0b013e3182a125f3.

DOI:10.1097/PCC.0b013e3182a125f3

PMID:24141657

Abstract

OBJECTIVE

This study was undertaken to document the real impact of a directed shift in the standard of neonatal practice to a pervasive use of noninvasive respiratory support.

DESIGN

Before-after observational study.

SETTING

All 18 neonatal ICUs in the capital region of Poland.

PATIENTS

Every infant admitted to a neonatal ICU who received respiratory pressure support over a 7-year period of interest (12-month transition to the new noninvasive standard and 36 months before and after).

INTERVENTION

Education as to the benefits of noninvasive respiratory support and widespread availability of Infant Flow noninvasive ventilation systems.

MEASUREMENTS AND MAIN RESULTS

Five thousand five hundred fifty-one infants required respiratory support in this period. Of these, 14% were less than 28 weeks estimated gestational age, 33% between 28 and 32 weeks, 31% between 33 and 36 weeks, and 22% more than 36 weeks. The use of noninvasive support, as the first form of respiratory support, increased by 19% (p < 0.001). The use of noninvasive support, for weaning following extubation, increased by 32% (p = 0.06). The increased use in weaning was the most pronounced in infants younger than or equal to 32 weeks estimated gestational age (p < 0.001). There were two prospective primary endpoints, mortality and bad outcome among survivors younger than or equal to 32 weeks estimated gestational age. Mortality decreased from 11% to 7%, and the difference remained statistically significant after controlling for baseline factors (p < 0.001). The reduced mortality was more apparent in infants younger than or equal to 32 weeks estimated gestational age. In infants younger than or equal to 32 weeks estimated gestational age, bad outcome in survivors (grade III bronchopulmonary dyplasia and retinopathy of prematurity requiring laser treatment) did not increase (p = 0.669) after controlling for significant baseline variables.

CONCLUSIONS

We believe that the adoption of an approach emphasizing noninvasive ventilation in Poland resulted in decreased mortality without an increase in significant pulmonary or retinal morbidity.

摘要

目的

本研究旨在记录标准新生儿实践向普遍使用无创呼吸支持的转变所产生的实际影响。

设计

前后观察研究。

地点

波兰首都地区的 18 个新生儿重症监护病房。

患者

在 7 年的研究期间内，每一位接受呼吸压力支持的入住新生儿重症监护病房的婴儿。

干预措施

进行有关无创呼吸支持益处的教育，并广泛提供婴儿流量无创通气系统。

测量和主要结果

在此期间，有 5551 名婴儿需要呼吸支持。其中，14%的婴儿估计胎龄小于 28 周，33%的婴儿胎龄在 28 至 32 周之间，31%的婴儿胎龄在 33 至 36 周之间，22%的婴儿胎龄大于 36 周。作为初始呼吸支持形式的无创支持使用率增加了 19%（p < 0.001）。用于拔管后脱机的无创支持使用率增加了 32%（p = 0.06）。在估计胎龄小于或等于 32 周的婴儿中，这种脱机时的使用增加最为明显（p < 0.001）。有两个前瞻性主要终点，即估计胎龄小于或等于 32 周的幸存者的死亡率和不良结局。死亡率从 11%降至 7%，且在控制了基线因素后差异仍具有统计学意义（p < 0.001）。在估计胎龄小于或等于 32 周的婴儿中，死亡率降低更为明显。在估计胎龄小于或等于 32 周的婴儿中，幸存者的不良结局（III 级支气管肺发育不良和需要激光治疗的早产儿视网膜病变）并没有增加（p = 0.669），在控制了重要的基线变量后。