Kawaguchi Atsushi, Yasui Yutaka, deCaen Allan, Garros Daniel
1Department of Pediatrics, Pediatric Critical Care Medicine, University of Alberta, Edmonton, AB. 2School of Public Health, University of Alberta, Edmonton, AB.
Pediatr Crit Care Med. 2017 Feb;18(2):112-119. doi: 10.1097/PCC.0000000000000985.
To assess the impact on a single PICU of introducing high-flow nasal cannula as a management tool for respiratory distress.
Retrospective cohort study, including an interrupted time series analysis with a propensity score adjustment and a matched-pair analysis.
A single university-affiliated children's hospital PICU.
None.
Differences in clinical outcomes when comparing the pre-high-flow nasal cannula era (2004-2008) and the high-flow nasal cannula era (2010-2014), excluding 2009 as a washout period, and clinical impacts of high-flow nasal cannula as an exposure of interest. A total of 1,766 children met the inclusion criteria (pre-high-flow nasal cannula era: 699 patients; high-flow nasal cannula era: 1,067 patients). High-flow nasal cannula was used in 455 patients (42.6%) in the high-flow nasal cannula era. The interrupted time series analysis failed to show a statistically significant difference in PICU length of stay, but the duration of invasive ventilation was shortened by an average of 2.3 days in the high-flow nasal cannula era group (95% CI, 0.2-4.4; p = 0.030). The PICU intubation rate in the high-flow nasal cannula era was 0.72 times that of the pre-high-flow nasal cannula era (95% CI, 0.63-0.84; p < 0.001). A total of 373 pairs were formed for the matched-pair analysis. The odds for being intubated in the PICU for those patients using high-flow nasal cannula was 0.06 (95% CI, 0.02-0.16; p < 0.001) when compared with those who did not use high-flow nasal cannula. The PICU length of stay increased by 2.9 days in those patients in which high-flow nasal cannula was used (95% CI, 1.3-4.4; p < 0.001).
The introduction of high-flow nasal cannula as a therapy for respiratory distress in the PICU was associated with a significant decrease in the PICU intubation rate with no associated change in mortality.
评估将高流量鼻导管作为呼吸窘迫管理工具对单一儿科重症监护病房（PICU）的影响。
回顾性队列研究，包括采用倾向评分调整的中断时间序列分析和配对分析。
一所大学附属医院的儿科重症监护病房。
无。
比较高流量鼻导管使用前时代（2004 - 2008年）和高流量鼻导管时代（2010 - 2014年）（将2009年作为洗脱期排除在外）的临床结局差异，以及将高流量鼻导管作为感兴趣暴露因素的临床影响。共有1766名儿童符合纳入标准（高流量鼻导管使用前时代：699例患者；高流量鼻导管时代：1067例患者）。在高流量鼻导管时代，455例患者（42.6%）使用了高流量鼻导管。中断时间序列分析未显示PICU住院时间有统计学显著差异，但高流量鼻导管时代组的有创通气时间平均缩短了2.3天（95%置信区间，0.2 - 4.4；p = 0.030）。高流量鼻导管时代的PICU插管率是高流量鼻导管使用前时代的0.72倍（95%置信区间，0.63 - 0.84；p < 0.001）。配对分析共形成373对。与未使用高流量鼻导管的患者相比，表示使用高流量鼻导管的患者在PICU接受插管的几率为0.06（95%置信区间，0.02 - 0.16；p < 0.001）。使用高流量鼻导管的患者PICU住院时间增加了2.9天（95%置信区间，1.3 - 4.4；p < 0.001）。
在PICU引入高流量鼻导管作为呼吸窘迫的治疗方法与PICU插管率显著降低相关，且死亡率无相关变化。
