Pons-Òdena Martí, Medina Alberto, Modesto Vicente, Martín-Mateos María Anunciación, Tan Wooi, Escuredo Laura, Cambra Francisco José
Hospital Sant Joan de Déu , Esplugues de Llobregat, Barcelona, España.
Hospital Universitario Central de Asturias, Oviedo, España.
An Pediatr (Engl Ed). 2019 Nov;91(5):307-316. doi: 10.1016/j.anpedi.2019.01.013. Epub 2019 Feb 20.
Despite there being limited evidence, non-invasive ventilation (NIV) has become a common treatment for acute respiratory failure (ARF). The aim of this study was to identify the predictive factors of NIV failure, in order to enable early detection of patients failing the treatment.
Prospective cohort study was conducted that included all ARF patients that received NIV as the initial treatment between 2005 and 2009 in a fourteen-bed Paediatric Intensive Care Unit (PICU) of a tertiary university hospital. Information was collected about the NIV, as well as clinical data prior to NIV, at 2, 8, 12, and 24hrs. The haemoglobin saturation (SpO2)/fraction of inspired oxygen (FiO2) ratio (S/F) was retrospectively calculated. NIV failure was defined as the need for intubation or requiring rescue with bi-level pressure (BLPAP). Univariate and multivariate statistical analyses were performed.
A total of 282 patients received non-invasive support, with 71 receiving Continuous Pressure (CPAP), and 211 with BLPAP treatment. The overall success rate was 71%. Patients receiving BLPAP vs. CPAP, patients with higher S/F ratios at 2hours (odds ratio [OR] 0.991, 95% CI 0.986-0.996, P=.001], and patients older than 6 months (Hazard ratio [HZ] 0.375, 95% CI 0.171-0.820, P=.014], were also more likely to fail. Patients with higher heart rates (HR) at 2hours (OR 1.021, 95% CI [1.008-1.034], P=.001) and higher inspiratory positive airway pressure (IPAP) at 2hours were more prone to failure (HZ 1.214, 95% CI [1.046-1.408], P=.011).
Age below 6 months, S/F ratio, HR, and IPAP at 2hours are independent predictive factors for initial NIV failure in paediatric patients with ARF admitted to the PICU.
尽管证据有限，但无创通气（NIV）已成为急性呼吸衰竭（ARF）的常见治疗方法。本研究的目的是确定NIV失败的预测因素，以便能够早期发现治疗失败的患者。
进行了一项前瞻性队列研究，纳入了2005年至2009年期间在一所三级大学医院的14张床位的儿科重症监护病房（PICU）接受NIV作为初始治疗的所有ARF患者。收集了有关NIV的信息以及NIV前、2小时、8小时、12小时和24小时的临床数据。回顾性计算血红蛋白饱和度（SpO2）/吸入氧分数（FiO2）比值（S/F）。NIV失败定义为需要插管或需要双水平压力（BLPAP）抢救。进行了单因素和多因素统计分析。
共有282例患者接受了无创支持，其中71例接受持续气道正压通气（CPAP），211例接受双水平气道正压通气（BLPAP）治疗。总体成功率为71%。接受BLPAP与CPAP治疗的患者、2小时时S/F比值较高的患者（比值比[OR]0.991，95%可信区间[CI]0.986-0.996，P=0.001）以及年龄大于6个月的患者（风险比[HZ]0.375，95%CI0.171-0.820，P=0.014）也更有可能失败。2小时时心率（HR）较高的患者（OR1.021，95%CI[1.008-1.034]，P=0.001）和2小时时吸气气道正压（IPAP）较高的患者更容易失败（HZ1.214，95%CI[1.046-1.408]，P=0.011）。
6个月以下的年龄、2小时时的S/F比值、HR和IPAP是入住PICU的ARF儿科患者初始NIV失败的独立预测因素。
