Andersen Lars W, Vognsen Mikael, Topjian Alexis, Brown Linda, Berg Robert A, Nadkarni Vinay M, Kirkegaard Hans, Donnino Michael W
1Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA. 2Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark. 3Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark. 4Department of Anesthesiology, Critical Care and Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. 5Department of Emergency Medicine, Hasbro Children's Hospital, Providence, RI. 6Division of Pulmonary and Critical Care Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA.
Pediatr Crit Care Med. 2017 Sep;18(9):838-849. doi: 10.1097/PCC.0000000000001204.
The main objectives of this study were to describe in-hospital acute respiratory compromise among children (< 18 yr old), and its association with cardiac arrest and in-hospital mortality.
Observational study using prospectively collected data.
U.S. hospitals reporting data to the "Get With The Guidelines-Resuscitation" registry.
Pediatric patients (< 18 yr old) with acute respiratory compromise. Acute respiratory compromise was defined as absent, agonal, or inadequate respiration that required emergency assisted ventilation and elicited a hospital-wide or unit-based emergency response.
None.
The primary outcome was in-hospital mortality. Cardiac arrest during the event was a secondary outcome. To assess the association between patient, event, and hospital characteristics and the outcomes, we created multivariable logistic regressions models accounting for within-hospital clustering. One thousand nine hundred fifty-two patients from 151 hospitals were included. Forty percent of the events occurred on the wards, 19% in the emergency department, 25% in the ICU, and 16% in other locations. Two hundred eighty patients (14.6%) died before hospital discharge. Preexisting hypotension (odds ratio, 3.26 [95% CI, 1.89-5.62]; p < 0.001) and septicemia (odds ratio, 2.46 [95% CI, 1.52-3.97]; p < 0.001) were associated with increased mortality. The acute respiratory compromise event was temporally associated with a cardiac arrest in 182 patients (9.3%), among whom 46.2% died. One thousand two hundred eight patients (62%) required tracheal intubation during the event. In-hospital mortality among patients requiring tracheal intubation during the event was 18.6%.
In this large, multicenter study of acute respiratory compromise, 40% occurred in ward settings, 9.3% had an associated cardiac arrest, and overall in-hospital mortality was 14.6%. Preevent hypotension and septicemia were associated with increased mortality rate.
本研究的主要目的是描述18岁以下儿童的院内急性呼吸功能不全情况，及其与心脏骤停和院内死亡率的关联。
使用前瞻性收集数据的观察性研究。
向“遵循指南-复苏”登记处报告数据的美国医院。
患有急性呼吸功能不全的儿科患者（<18岁）。急性呼吸功能不全定义为呼吸缺失、濒死呼吸或呼吸不足，需要紧急辅助通气并引发全院或科室范围的应急响应。
无。
主要结局为院内死亡率。事件期间的心脏骤停为次要结局。为评估患者、事件和医院特征与结局之间的关联，我们创建了考虑院内聚集性的多变量逻辑回归模型。纳入了来自151家医院的1952例患者。40%的事件发生在病房，19%在急诊科，25%在重症监护室，16%在其他地点。280例患者（14.6%）在出院前死亡。既往存在低血压（比值比，3.26 [95%置信区间，1.89 - 5.62]；p < 0.001）和败血症（比值比，2.46 [95%置信区间，1.52 - 3.97]；p < 0.001）与死亡率增加相关。182例患者（9.3%）的急性呼吸功能不全事件在时间上与心脏骤停相关，其中46.2%死亡。1208例患者（62%）在事件期间需要气管插管。事件期间需要气管插管的患者院内死亡率为18.6%。
在这项关于急性呼吸功能不全的大型多中心研究中，40%发生在病房环境，9.3%伴有心脏骤停，总体院内死亡率为14.6%。事件前低血压和败血症与死亡率增加相关。
