Wolfler Andrea, Calderini Edoardo, Iannella Elisa, Conti Giorgio, Biban Paolo, Dolcini Anna, Pirozzi Nicola, Racca Fabrizio, Pettenazzo Andrea, Salvo Ida
1Department of Anesthesia and Intensive Care, Children's Hospital V Buzzi, Milan, Italy. 2Department of Anesthesia and Intensive Care, Fondazione IRCCS Ca Granda, Ospedale Maggiore Policlinico, Milan, Italy. 3Department of Pediatric Anesthesia and Intensive Care, Ospedale Sant'Orsola Malpighi, Bologna, Italy. 4Pediatric ICU, Anesthesia and Intensive Care Department, Policlinico Universitario A.Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy. 5Department of Neonatal and Paediatric Intensive Care, Azienda Ospedaliera Universitaria Integrata, Verona, Italy. 6Department of Anesthesia and Intensive Care, Children's Hospital Santobono-Pausillipon, Napoli, Italy. 7Department of Anesthesia and Intensive Care, Children's Hospital Bambino Gesù, Rome, Italy 8Department of Anesthesia and Intensive Care, Children's Hospital Sant'Antonio e Biagio e Cesare Arrigo, Alessandria, Italy. 9Pediatric ICU, Pediatric Department, Ospedale Civile, Padova, Italy.
Pediatr Crit Care Med. 2015 Jun;16(5):418-27. doi: 10.1097/PCC.0000000000000387.
To assess how clinical practice of noninvasive ventilation has evolved in the Italian PICUs.
National, multicentre, retrospective, observational cohort.
Thirteen Italian medical/surgical PICUs that participated in the Italian PICU Network.
Seven thousand one-hundred eleven admissions of children with 0-16 years old admitted from January 1, 2011, to December 31, 2012.
None.
Cause of respiratory failure, length and mode of noninvasive ventilation, type of interfaces, incidence of treatment failure, and outcome were recorded. Data were compared with an historical cohort of children enrolled along 6 months from November 1, 2006, to April 30, 2007, over the viral respiratory season. Seven thousand one-hundred eleven PICU admissions were analyzed, and an overall noninvasive ventilation use of 8.8% (n = 630) was observed. Among children who were admitted in the PICU without mechanical ventilation (n = 3,819), noninvasive ventilation was used in 585 patients (15.3%) with a significant increment among the three study years (from 11.6% in 2006 to 18.2% in 2012). In the endotracheally intubated group, 17.2% children received noninvasive ventilation at the end of the weaning process to avoid reintubation: 11.9% in 2006, 15.3% in 2011, and 21.6% in 2012. Noninvasive ventilation failure rate raised from 10% in 2006 to 16.1% in 2012.
Noninvasive ventilation is increasingly and successfully used as first respiratory approach in several, but not all, Italian PICUs. The current study shows that noninvasive ventilation represents a feasible and safe technique of ventilatory assistance for the treatment of mild acute respiratory failure. Noninvasive ventilation was used as primary mode of ventilation in children with low respiratory tract infection (mainly in bronchiolitis and pneumonia), in acute on chronic respiratory failure or to prevent reintubation.
评估意大利儿科重症监护病房（PICU）无创通气的临床实践是如何演变的。
全国性、多中心、回顾性观察队列研究。
13家参与意大利PICU网络的意大利医疗/外科PICU。
2011年1月1日至2012年12月31日期间收治的7111例0至16岁儿童。
无。
记录呼吸衰竭的原因、无创通气的时长和模式、接口类型、治疗失败的发生率及转归。将数据与2006年11月1日至2007年4月30日这6个月的病毒性呼吸道感染季节期间纳入的儿童历史队列进行比较。分析了7111例PICU入院病例，观察到无创通气的总体使用率为8.8%（n = 630）。在未接受机械通气的PICU入院儿童中（n = 3819），585例患者（15.3%）使用了无创通气，在三个研究年份中显著增加（从2006年的11.6%增至2012年的18.2%）。在气管插管组中，17.2%的儿童在撤机过程结束时接受无创通气以避免再次插管：2006年为11.9%，2011年为15.3%，2012年为21.6%。无创通气失败率从2006年的10%升至2012年的16.1%。
在意大利的部分（但并非全部）PICU中，无创通气越来越多地被成功用作首要呼吸支持方法。当前研究表明，无创通气是治疗轻度急性呼吸衰竭的一种可行且安全的通气辅助技术。无创通气被用作下呼吸道感染（主要是细支气管炎和肺炎）、慢性呼吸衰竭急性加重或预防再次插管患儿的主要通气模式。
