Mortamet G, Emeriaud G, Jouvet P, Fauroux B, Essouri S
Unité de soins intensifs pédiatriques, CHU Sainte-Justine, 3175 côte Sainte-Catherine, QC H3T 1C4 Montréal, Canada; Université de Montréal, 2900, boulevard Édouard-Monpetit, QC H3T 1J4 Montréal, Canada; Unité Inserm U955, équipe 13, institut de recherche biomédicale Mondor, 8, rue du Général-Sarrail, 94000 Créteil, France.
Unité de soins intensifs pédiatriques, CHU Sainte-Justine, 3175 côte Sainte-Catherine, QC H3T 1C4 Montréal, Canada; Université de Montréal, 2900, boulevard Édouard-Monpetit, QC H3T 1J4 Montréal, Canada.
Arch Pediatr. 2017 Jan;24(1):58-65. doi: 10.1016/j.arcped.2016.10.012. Epub 2016 Nov 23.
Respiratory failure is the leading cause of hospital admissions in the pediatric intensive care unit (PICU) and is associated with significant morbidity and mortality. Mechanical ventilation, preferentially delivered by a non-invasive route (NIV), is currently the first-line treatment for respiratory failure since it is associated with a reduction in the intubation rate. This ventilatory support is increasingly used in the PICU, but its wider use contrasts with the paucity of studies in this field. This review aims to describe the main indications of NIV in acute settings: (i) bronchiolitis; (ii) postextubation respiratory failure; (iii) acute respiratory distress syndrome; (iv) pneumonia; (v) status asthmaticus; (vi) acute chest syndrome; (vii) left heart failure; (viii) exacerbation of chronic respiratory failure; (ix) upper airway obstruction and (x) end-of-life care. Most of these data are based on descriptive studies and expert opinions, and few are from randomized trials. While the benefit of NIV is significant in some indications, such as bronchiolitis, it is more questionable in others. Monitoring these patients for the occurrence of NIV failure markers is crucial.
呼吸衰竭是儿科重症监护病房（PICU）住院的主要原因，且与显著的发病率和死亡率相关。机械通气优先通过无创途径（NIV）进行，目前是呼吸衰竭的一线治疗方法，因为它与插管率降低有关。这种通气支持在PICU中使用越来越多，但其广泛应用与该领域研究的匮乏形成对比。本综述旨在描述NIV在急性情况下的主要适应证：（i）细支气管炎；（ii）拔管后呼吸衰竭；（iii）急性呼吸窘迫综合征；（iv）肺炎；（v）哮喘持续状态；（vi）急性胸综合征；（vii）左心衰竭；（viii）慢性呼吸衰竭急性加重；（ix）上气道梗阻；（x）临终关怀。这些数据大多基于描述性研究和专家意见，很少来自随机试验。虽然NIV在某些适应证（如细支气管炎）中益处显著，但在其他适应证中则更值得怀疑。监测这些患者是否出现NIV失败标志物至关重要。
