Division of Pediatric Critical Care, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas; Division of Pediatric Cardiology, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Division of Biostatistics, Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Ann Allergy Asthma Immunol. 2014 Jul;113(1):42-7. doi: 10.1016/j.anai.2014.04.020. Epub 2014 May 14.
Little is known about the relation between center volume and outcomes in children requiring intensive care unit (ICU) admission for acute asthma.
To evaluate the association of center volume with the odds of receiving positive pressure ventilation and length of ICU stay.
Patients 2 to 18 years of age with the primary diagnosis of asthma were included (2009-2012). Center volume was defined as the average number of mechanical ventilator cases per year for any diagnoses during the study period. In multivariable analysis, the odds of receiving positive pressure ventilation (invasive and noninvasive ventilation) and ICU length of stay were evaluated as a function of center volume.
Fifteen thousand eighty-three patients from 103 pediatric ICUs with the primary diagnosis of acute asthma met the inclusion criteria. Seven hundred fifty-two patients (5%) received conventional mechanical ventilation and 964 patients (6%) received noninvasive ventilation. In multivariable analysis, center volume was not associated with the odds of receiving any form of positive pressure ventilation in children with acute asthma, with the exception of high- to medium-volume centers. However, ICU length of stay varied with center volume and was noted to be longer in low-volume centers compared with medium- and high-volume centers.
In children with acute asthma, this study establishes a relation between center volume and ICU length of stay. However, this study fails to show any significant relation between center volume and the odds of receiving positive pressure ventilation; further analyses are needed to evaluate this relation in more detail.
对于需要入住重症监护病房（ICU）治疗急性哮喘的儿童，中心容量与结局之间的关系知之甚少。
评估中心容量与接受正压通气的几率和 ICU 住院时间之间的关系。
纳入年龄在 2 至 18 岁、主要诊断为哮喘的患者（2009-2012 年）。中心容量定义为研究期间任何诊断的机械通气例数的平均值。在多变量分析中，评估了中心容量与接受正压通气（有创和无创通气）和 ICU 住院时间的几率之间的关系。
来自 103 家儿科 ICU 的 15083 名患有急性哮喘的患者符合纳入标准。752 名患者（5%）接受常规机械通气，964 名患者（6%）接受无创通气。在多变量分析中，除了高至中容量中心外，中心容量与急性哮喘儿童接受任何形式正压通气的几率无关。然而，ICU 住院时间随中心容量而变化，与中、高容量中心相比，低容量中心的 ICU 住院时间更长。
在急性哮喘儿童中，本研究确立了中心容量与 ICU 住院时间之间的关系。然而，本研究未能显示中心容量与接受正压通气几率之间存在任何显著关系；需要进一步分析以更详细地评估这种关系。
