Toledo del Castillo B, Fernández Lafever S N, López Sanguos C, Díaz-Chirón Sánchez L, Sánchez da Silva M, López-Herce Cid J
Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Instituto de Investigación del Hospital General Universitario Gregorio Marañón, Madrid, Red de Salud Maternoinfantil y del Desarrollo (Red SAMID), Madrid, España.
Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Instituto de Investigación del Hospital General Universitario Gregorio Marañón, Madrid, Red de Salud Maternoinfantil y del Desarrollo (Red SAMID), Madrid, España.
An Pediatr (Barc). 2015 Aug;83(2):117-22. doi: 10.1016/j.anpedi.2014.11.006. Epub 2014 Dec 19.
The aim of the study was to analyse the evolution, over a12-year period, of the use of non-invasive (NIV) and invasive ventilation (IV) in children admitted to a Paediatric Intensive Care Unit (PICU) due to acute bronchiolitis.
A retrospective observational study was performed including all children who were admitted to the PICU requiring NIV or IV between 2001 and 2012. Demographic characteristics, ventilation assistance and clinical outcome were analysed. A comparison was made between the first six years and the last 6 years of the study.
A total of 196 children were included; 30.1% of the subjects required IV and 93.3% required NIV. The median duration of IV was 9.5 days and NIV duration was 3 days. The median PICU length of stay was 7 days, and 2% of the patients died. The use of NIV increased from 79.4% in first period to 100% in the second period (P<.0001) and IV use decreased from 46% in first period to 22.6% in the last 6 years (P<.0001). Continuous positive airway pressure and nasopharyngeal tube were the most frequently used modality and interface, although the use of bi-level non-invasive ventilation (P<.001) and of nasal cannulas significantly increased (P<.0001) in the second period, and the PICU length of stay was shorter (P=.011).
The increasing use of NIV in bronchiolitis in our PICU during the last 12 years was associated with a decrease in the use of IV and length of stay in the PICU.
本研究旨在分析因急性细支气管炎入住儿科重症监护病房（PICU）的儿童在12年期间无创通气（NIV）和有创通气（IV）的使用演变情况。
进行一项回顾性观察研究，纳入2001年至2012年间入住PICU需要NIV或IV的所有儿童。分析人口统计学特征、通气支持情况及临床结局。对研究的前六年和后六年进行比较。
共纳入196名儿童；30.1%的受试者需要IV，93.3%需要NIV。IV的中位持续时间为9.5天，NIV持续时间为3天。PICU的中位住院时间为7天，2%的患者死亡。NIV的使用从第一阶段的79.4%增加到第二阶段的100%（P<0.0001），IV的使用从第一阶段的46%下降到最后六年的22.6%（P<0.0001）。持续气道正压通气和鼻咽管是最常用的模式和接口，尽管在第二阶段双水平无创通气的使用（P<0.001）和鼻导管的使用显著增加（P<0.0001），且PICU住院时间更短（P = 0.011）。
在过去12年中，我们PICU在细支气管炎治疗中NIV使用的增加与IV使用的减少及PICU住院时间的缩短相关。
