在儿科重症监护病房接受气管切开术或开始长期通气的儿童和青少年。
Children and Young Adults Who Received Tracheostomies or Were Initiated on Long-Term Ventilation in PICUs.
作者信息
Edwards Jeffrey D, Houtrow Amy J, Lucas Adam R, Miller Rachel L, Keens Thomas G, Panitch Howard B, Dudley R Adams
机构信息
1Division of Pediatric Critical Care, Department of Pediatrics, Columbia University College of Physician and Surgeons, New York, NY. 2Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA. 3Department of Statistics, University of California, Berkeley, CA. 4Division of Pulmonary, Allergy and Critical Care Medicine, Department of Pediatrics, Columbia University College of Physician and Surgeons, New York, NY. 5Division of Pediatric Allergy, Immunology and Rheumatology, Department of Pediatrics, Columbia University College of Physician and Surgeons, New York, NY. 6Division of Pediatric Pulmonology, Department of Pediatrics, Keck School of Medicine of University of Southern California, Los Angeles, CA. 7Division of Pulmonary Medicine, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA. 8Division of Pulmonary and Critical Care, Department of Pediatrics, University of California, San Francisco, CA. 9Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA.
出版信息
Pediatr Crit Care Med. 2016 Aug;17(8):e324-34. doi: 10.1097/PCC.0000000000000844.
OBJECTIVES
To characterize patients who received tracheostomies for airway compromise or were initiated on long-term ventilation for chronic respiratory failure in PICUs and to examine variation in the incidence of initiation, patient characteristics, and modalities across sites.
DESIGN
Retrospective cross-sectional analysis.
SETTINGS
Seventy-three North American PICUs that participated in the Virtual Pediatric Systems, LLC.
PATIENTS
PICU patients admitted between 2009 and 2011.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
Among 115,437 PICU patients, 1.8% received a tracheostomy or were initiated on long-term ventilation; 1,034 received a tracheostomy only, 717 were initiated on invasive ventilation, and 381 were initiated on noninvasive ventilation. Ninety percent had substantial chronic conditions and comorbidities, including more than 50% with moderate or worse cerebral disability upon discharge. Seven percent were initiated after a catastrophic injury/event. Across sites, there was variation in incidence of tracheotomy and initiation of long-term ventilation, ranging from 0% to 4.6%. There also was variation in patient characteristics, time to tracheotomy, number of extubations prior to tracheostomy, and the use of invasive ventilation versus noninvasive ventilation.
CONCLUSIONS
Although the PICU incidence of initiation of tracheostomies and long-term ventilation was relatively uncommon, it suggests that thousands of children and young adults receive these interventions each year in North American PICUs. The majority of them have conditions and comorbidities that impose on-going care needs, beyond those required by artificial airways and long-term ventilation themselves.
目的
对在儿科重症监护病房（PICU）因气道受损接受气管切开术或因慢性呼吸衰竭开始长期通气的患者进行特征描述，并研究不同机构在开始治疗的发生率、患者特征及治疗方式上的差异。
设计
回顾性横断面分析。
研究地点
73家参与虚拟儿科系统有限责任公司的北美PICU。
患者
2009年至2011年期间入住PICU的患者。
干预措施
无。
测量指标及主要结果
在115437例PICU患者中，1.8%接受了气管切开术或开始长期通气；1034例仅接受了气管切开术，717例开始有创通气，381例开始无创通气。90%有严重的慢性疾病和合并症，包括超过50%出院时伴有中度或更严重的脑功能障碍。7%在发生灾难性损伤/事件后开始治疗。不同机构之间，气管切开术和长期通气开始治疗的发生率存在差异，范围从0%至4.6%。在患者特征、气管切开术时间、气管切开术前拔管次数以及有创通气与无创通气的使用方面也存在差异。
结论
尽管在PICU中开始气管切开术和长期通气的发生率相对较低，但这表明北美每年有成千上万的儿童和年轻人接受这些治疗。他们中的大多数患有各种疾病和合并症，除了人工气道和长期通气本身所需的护理外，还需要持续的护理。
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