1Department of Anesthesiology, Perioperative and Pain Medicine, Division of Critical Care Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA. 2Children's Medical Center of Dallas, Dallas, TX. 3Neonatal and Pediatric Intensive Care Unit, Department of Pediatrics, University Hospital of Geneva, Geneva, Switzerland. 4Czech Technical University in Prague, Kladno, Czech Republic. 5Department of Pediatric Intensive Care, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands. 6Pediatric Intensive Care, Queen Paola Children's Hospital, Antwerp, Belgium. 7Division of Pediatric Intensive Care, Department of Pediatrics, VU University Medical Center, Amsterdam, The Netherlands. 8The Hospital for Sick Children, Toronto, ON, Canada.
Crit Care Med. 2015 Dec;43(12):2660-7. doi: 10.1097/CCM.0000000000001278.
We aim to describe current clinical practice, the past decade of experience and factors related to improved outcomes for pediatric patients receiving high-frequency oscillatory ventilation. We have also modeled predictive factors that could help stratify mortality risk and guide future high-frequency oscillatory ventilation practice.
Multicenter retrospective, observational questionnaire study.
Seven PICUs.
Demographic, disease factor, and ventilatory and outcome data were collected, and 328 patients from 2009 to 2010 were included in this analysis.
None.
Patients were classified into six cohorts based on underlying diagnosis. We used univariate analysis to identify factors associated with mortality risk and multivariate logistic regression to identify independent predictors of mortality risk. An oxygenation index greater than 35 and immunocompromise exhibited the greatest predictive power (p < 0.0001) for increased mortality risk, and respiratory syncytial virus was associated with lowest mortality risk (p = 0.003). Differences in mortality risk as a function of oxygenation index were highly dependent on primary underlying condition. A trend toward an increase in oscillator amplitude and frequency was observed when compared with historical data.
Given the number of centers and subjects included in the database, these findings provide a robust description of current practice regarding the use of high-frequency oscillatory ventilation for pediatric hypoxic respiratory failure. Patients with severe hypoxic respiratory failure and immunocompromise had the highest mortality risk, and those with respiratory syncytial virus had the lowest. A means of identifying the risk of 30-day mortality for subjects can be obtained by identifying the underlying disease and oxygenation index on conventional ventilation preceding the initiation of high-frequency oscillatory ventilation.
我们旨在描述目前儿科高频振荡通气治疗患者的临床实践、过去十年的经验以及与改善预后相关的因素。我们还建立了预测模型，以帮助分层死亡率风险并指导未来高频振荡通气的实践。
多中心回顾性观察问卷调查研究。
7 个 PICUs。
收集了人口统计学、疾病因素、通气和结局数据，纳入了 2009 年至 2010 年的 328 名患者进行本分析。
无。
根据基础诊断将患者分为六组。我们使用单因素分析确定与死亡风险相关的因素，并使用多因素逻辑回归确定死亡风险的独立预测因素。氧合指数大于 35 和免疫抑制与更高的死亡率风险（p<0.0001）具有最大的预测能力，而呼吸道合胞病毒与最低的死亡率风险相关（p=0.003）。氧合指数作为死亡率风险函数的差异高度依赖于主要基础疾病。与历史数据相比，观察到振荡器幅度和频率增加的趋势。
考虑到数据库中的中心和患者数量，这些发现为高频振荡通气治疗儿科低氧性呼吸衰竭的当前实践提供了可靠的描述。患有严重低氧性呼吸衰竭和免疫抑制的患者死亡率风险最高，而患有呼吸道合胞病毒的患者死亡率风险最低。通过识别在开始高频振荡通气之前常规通气时的基础疾病和氧合指数，可以获得识别对象 30 天死亡率风险的方法。
