Division of Critical Care Medicine, Department of Pediatrics, University of Alabama at Birmingham School of Medicine, Birmingham, AL.
Department of Pediatrics, Section of Cardiology, University of Cincinnati College of Medicine, Cardiac Intensive Care Unit, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Pediatr Crit Care Med. 2019 Feb;20(2):149-157. doi: 10.1097/PCC.0000000000001783.
Compare the impact of initial extubation to positive airway pressure versus high-flow nasal cannula on postoperative outcomes in neonates and infants after congenital heart surgery.
Retrospective cohort study with propensity-matched analysis.
Cardiac ICU within a tertiary care children's hospital.
Patients less than 6 months old initially extubated to either high-flow nasal cannula or positive airway pressure after cardiac surgery with cardiopulmonary bypass were included (July 2012 to December 2015).
None.
Of 258 encounters, propensity matching identified 49 pairings of patients extubated to high-flow nasal cannula versus positive airway pressure. Extubation failure was 12% for all screened encounters. After matching, there was no difference in extubation failure rate between groups (positive airway pressure 16% vs high-flow nasal cannula 10%; p = 0.549). However, compared with high-flow nasal cannula, patients initially extubated to positive airway pressure experienced greater resource utilization: longer time to low-flow nasal cannula (83 vs 28 hr; p = 0.006); longer time to room air (159 vs 110 hr; p = 0.013); and longer postsurgical hospital length of stay (22 vs 14 d; p = 0.015).
In this pediatric cohort, primary extubation to positive airway pressure was not superior to high-flow nasal cannula with respect to prevention of extubation failure after congenital heart surgery. Compared with high-flow nasal cannula, use of positive airway pressure was associated with increased hospital resource utilization. Prospective initiatives aimed at establishing best clinical practice for postoperative noninvasive respiratory support are needed.
比较先天性心脏手术后新生儿和婴儿最初经气管插管拔管改为经鼻高流量或持续气道正压通气对术后结局的影响。
回顾性队列研究，采用倾向性匹配分析。
一家三级儿童保健医院的心脏重症监护病房。
接受体外循环心脏手术后最初经气管插管改为经鼻高流量或持续气道正压通气的年龄小于 6 个月的患者（2012 年 7 月至 2015 年 12 月）。
无。
258 次就诊中，通过倾向性匹配共确定了 49 对经鼻高流量与持续气道正压通气的患者。所有筛选的患者中，拔管失败的比例为 12%。匹配后，两组的拔管失败率无差异（持续气道正压通气组 16%，经鼻高流量组 10%；p = 0.549）。然而，与经鼻高流量相比，最初经气管插管改为持续气道正压通气的患者需要更多的资源利用：低流量鼻导管通气时间更长（83 小时 vs 28 小时；p = 0.006）；过渡到空气通气时间更长（159 小时 vs 110 小时；p = 0.013）；以及术后住院时间更长（22 天 vs 14 天；p = 0.015）。
在本儿科队列中，与经鼻高流量相比，先天性心脏手术后最初经气管插管改为持续气道正压通气并不能更好地预防拔管失败。与经鼻高流量相比，使用持续气道正压通气与增加医院资源利用有关。需要制定针对术后非侵入性呼吸支持的最佳临床实践的前瞻性计划。
