Pediatric Intensive Care Unit, Department of Pediatrics, Hospital Universitario Central de Asturias, University of Oviedo, Oviedo, Spain.
Critical Care Research Group, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain Pediatric Intensive Care and Intermediate Care Department, Sant Joan de Déu University Hospital, Universitat de Barcelona, Esplugues de Llobregat, Spain.
Pediatr Pulmonol. 2018 Aug;53(8):1107-1114. doi: 10.1002/ppul.23988. Epub 2018 Mar 24.
To describe the diversity in practice in non-invasive ventilation (NIV) in European pediatric intensive care units (PICUs).
No information about the use of NIV in Pediatrics across Europe is currently available, and there might be a wide variability regarding the approach.
Cross-sectional electronic survey.
The survey was distributed to the ESPNIC mailing list and to researchers in different European centers.
One hundred one units from 23 countries participated. All respondent units used NIV. Almost all PICUs considered NIV as initial respiratory support (99.1%), after extubation (95.5% prophylactically, 99.1% therapeutically), and 77.5% as part of palliative care. Overall NIV use outside the PICUs was 15.5% on the ward, 20% in the emergency department, and 36.4% during transport. Regarding respiratory failure cause, NIV was delivered in pneumonia (97.3%), bronchiolitis (94.6%), bronchospasm (75.2%), acute pulmonary edema (84.1%), upper airway obstruction (76.1%), and in acute respiratory distress syndrome (91% if mild, 53.1% if moderate, and 5.3% if severe). NIV use in asthma was less frequent in Northern European units in comparison to Central and Southern European PICUs (P = 0.007). Only 47.7% of the participants had a written protocol about NIV use. Bilevel NIV was applied mostly through an oronasal mask (44.4%), and continuous positive airway pressure through nasal cannulae (39.8%). If bilevel NIV was required, 62.3% reported choosing pressure support (vs assisted pressure-controlled ventilation) in infants; and 74.5% in older children.
The present study shows that NIV is a widespread technique in European PICUs. Practice across Europe is variable.
描述欧洲儿科重症监护病房（PICU）中无创通气（NIV）的实践多样性。
目前尚无关于欧洲儿科 NIV 使用情况的信息，而且在方法上可能存在很大差异。
横断面电子调查。
调查分发给 ESPNIC 邮件列表和欧洲不同中心的研究人员。
来自 23 个国家的 101 个单位参与了研究。所有参与调查的单位都使用了 NIV。几乎所有的 PICU 都将 NIV 作为初始呼吸支持（99.1%），在拔管后（95.5%预防性，99.1%治疗性），以及 77.5%作为姑息治疗的一部分。总体而言，NIV 在 PICU 外的使用情况为：病房 15.5%，急诊室 20%，转运途中 36.4%。关于呼吸衰竭的原因，NIV 用于肺炎（97.3%）、细支气管炎（94.6%）、支气管痉挛（75.2%）、急性肺水肿（84.1%）、上呼吸道阻塞（76.1%）和急性呼吸窘迫综合征（轻度 91%，中度 53.1%，重度 5.3%）。与中欧和南欧 PICU 相比，北欧单位中哮喘使用 NIV 的情况较少（P=0.007）。只有 47.7%的参与者有关于 NIV 使用的书面方案。双水平 NIV 主要通过口鼻面罩（44.4%）应用，持续气道正压通过鼻导管（39.8%）应用。如果需要双水平 NIV，62.3%的人报告在婴儿中选择压力支持（与辅助压力控制通气相比）；在大龄儿童中，这一比例为 74.5%。
本研究表明，NIV 是欧洲 PICU 中广泛应用的技术。欧洲各地的实践存在差异。
