高频振荡通气与常规机械通气在小儿呼吸衰竭中的比较。

Comparison of high-frequency oscillatory ventilation and conventional mechanical ventilation in pediatric respiratory failure.

机构信息

Division of Pediatric Critical Care, Department of Pediatrics, University of Arkansas Medical Center, Little Rock2Division of Pediatric Cardiology, Department of Pediatrics, University of Arkansas Medical Center, Little Rock.

Division of Pediatric Critical Care, Department of Pediatrics, University of Arkansas Medical Center, Little Rock.

出版信息

JAMA Pediatr. 2014 Mar;168(3):243-9. doi: 10.1001/jamapediatrics.2013.4463.

DOI:10.1001/jamapediatrics.2013.4463

PMID:24445980

Abstract

IMPORTANCE

Outcomes associated with use of high-frequency oscillatory ventilation (HFOV) in children with acute respiratory failure have not been established.

OBJECTIVE

To compare the outcomes of HFOV with those of conventional mechanical ventilation (CMV) in children with acute respiratory failure.

DESIGN, SETTING, AND PARTICIPANTS: We performed a retrospective, observational study using deidentified data obtained from all consecutive patients receiving mechanical ventilation aged 1 month to 18 years in the Virtual PICU System database from January 1, 2009, through December 31, 2011. The study population was divided into 2 groups: HFOV and CMV. The HFOV group was further divided into early and late HFOV. Propensity score matching was performed as a 1-to-1 match of HFOV and CMV patients. A similar matching process was performed for early HFOV and CMV patients.

EXPOSURE

High-frequency oscillatory ventilation.

MAIN OUTCOMES AND MEASURES

Length of mechanical ventilation, intensive care unit (ICU) length of stay, ICU mortality, and standardized mortality ratio (SMR).

RESULTS

A total of 9177 patients from 98 hospitals qualified for inclusion. Of these, 902 (9.8%) received HFOV, whereas 8275 (90.2%) received CMV. A total of 1764 patients were matched to compare HFOV and CMV, whereas 942 patients were matched to compare early HFOV and CMV. Length of mechanical ventilation (CMV vs HFOV: 14.6 vs 20.3 days, P < .001; CMV vs early HFOV: 14.6 vs 15.9 days, P < .001), ICU length of stay (19.1 vs 24.9 days, P < .001; 19.3 vs 19.5 days, P = .03), and mortality (8.4% vs 17.3%, P < .001; 8.3% vs 18.1%, P < .001) were significantly higher in HFOV and early HFOV patients compared with CMV patients. The SMR in the HFOV group was 2.00 (95% CI, 1.71-2.35) compared with an SMR in the CMV group of 0.85 (95% CI, 0.68-1.07). The SMR in the early HFOV group was 1.62 (95% CI, 1.31-2.01) compared with an SMR in the CMV group of 0.76 (95% CI, 0.62-1.16).

CONCLUSIONS AND RELEVANCE

Application of HFOV and early HFOV compared with CMV in children with acute respiratory failure is associated with worse outcomes. The results of our study are similar to recently published studies in adults comparing these 2 modalities of ventilation for acute respiratory distress syndrome.

摘要

重要性

高频振荡通气（HFOV）在急性呼吸衰竭患儿中的应用效果尚不确定。

目的

比较高频振荡通气与常规机械通气（CMV）在急性呼吸衰竭患儿中的疗效。

设计、设置和参与者：我们使用从 2009 年 1 月 1 日至 2011 年 12 月 31 日来自所有连续接受机械通气的年龄在 1 个月至 18 岁的患者的虚拟 PICUSystem 数据库中获得的匿名数据进行了回顾性观察性研究。研究人群分为 2 组：HFOV 和 CMV。HFOV 组进一步分为早期 HFOV 和晚期 HFOV。采用 1:1 匹配的方法对 HFOV 和 CMV 患者进行倾向评分匹配。对早期 HFOV 和 CMV 患者进行了类似的匹配过程。

暴露

高频振荡通气。

主要结局和测量指标

机械通气时间、重症监护病房（ICU）住院时间、ICU 死亡率和标准化死亡率比（SMR）。

结果

共有 98 家医院的 9177 名患者符合纳入标准。其中，902 例（9.8%）接受 HFOV，8275 例（90.2%）接受 CMV。共有 1764 例患者进行了匹配以比较 HFOV 和 CMV，942 例患者进行了匹配以比较早期 HFOV 和 CMV。机械通气时间（CMV 与 HFOV：14.6 天与 20.3 天，P<0.001；CMV 与早期 HFOV：14.6 天与 15.9 天，P<0.001）、ICU 住院时间（19.1 天与 24.9 天，P<0.001；19.3 天与 19.5 天，P=0.03）和死亡率（8.4%与 17.3%，P<0.001；8.3%与 18.1%，P<0.001）在 HFOV 和早期 HFOV 患者中明显高于 CMV 患者。HFOV 组的 SMR 为 2.00（95%CI，1.71-2.35），CMV 组的 SMR 为 0.85（95%CI，0.68-1.07）。早期 HFOV 组的 SMR 为 1.62（95%CI，1.31-2.01），CMV 组的 SMR 为 0.76（95%CI，0.62-1.16）。