Peterson-Carmichael Stacey, Seddon Paul C, Cheifetz Ira M, Frerichs Inéz, Hall Graham L, Hammer Jürg, Hantos Zoltán, van Kaam Anton H, McEvoy Cindy T, Newth Christopher J L, Pillow J Jane, Rafferty Gerrard F, Rosenfeld Margaret, Stocks Janet, Ranganathan Sarath C
Ann Am Thorac Soc. 2016 Feb;13(2):S1-11. doi: 10.1513/AnnalsATS.201511-730ST.
Ready access to physiologic measures, including respiratory mechanics, lung volumes, and ventilation/perfusion inhomogeneity, could optimize the clinical management of the critically ill pediatric or neonatal patient and minimize lung injury. There are many techniques for measuring respiratory function in infants and children but very limited information on the technical ease and applicability of these tests in the pediatric and neonatal intensive care unit (PICU, NICU) environments. This report summarizes the proceedings of a 2011 American Thoracic Society Workshop critically reviewing techniques available for ventilated and spontaneously breathing infants and children in the ICU. It outlines for each test how readily it is performed at the bedside and how it may impact patient management as well as indicating future areas of potential research collaboration. From expert panel discussions and literature reviews, we conclude that many of the techniques can aid in optimizing respiratory support in the PICU and NICU, quantifying the effect of therapeutic interventions, and guiding ventilator weaning and extubation. Most techniques now have commercially available equipment for the PICU and NICU, and many can generate continuous data points to help with ventilator weaning and other interventions. Technical and validation studies in the PICU and NICU are published for the majority of techniques; some have been used as outcome measures in clinical trials, but few have been assessed specifically for their ability to improve clinical outcomes. Although they show considerable promise, these techniques still require further study in the PICU and NICU together with increased availability of commercial equipment before wider incorporation into daily clinical practice.
能够随时获取包括呼吸力学、肺容量以及通气/灌注不均一性等生理指标，可优化危重症儿科或新生儿患者的临床管理，并将肺损伤降至最低。有许多技术可用于测量婴幼儿的呼吸功能，但关于这些测试在儿科和新生儿重症监护病房（PICU、NICU）环境中的操作简便性和适用性的信息非常有限。本报告总结了2011年美国胸科学会研讨会的会议记录，该研讨会对ICU中机械通气和自主呼吸的婴幼儿可用的技术进行了严格审查。报告针对每项测试概述了其在床边的操作难易程度、对患者管理的可能影响，并指出了未来潜在的研究合作领域。通过专家小组讨论和文献综述，我们得出结论，许多技术有助于优化PICU和NICU中的呼吸支持、量化治疗干预的效果以及指导呼吸机撤机和拔管。现在大多数技术在PICU和NICU都有商用设备，而且许多技术可以生成连续的数据点，以帮助进行呼吸机撤机和其他干预。针对大多数技术，都有在PICU和NICU进行的技术和验证研究发表；有些技术已在临床试验中用作预后指标，但很少有技术专门评估其改善临床结局的能力。尽管这些技术显示出相当大的前景，但在更广泛地纳入日常临床实践之前，它们仍需要在PICU和NICU中进一步研究，并提高商用设备的可及性。
