Department of Anesthesiology and Intensive Care, Università Cattolica del Sacro Cuore, Fondzione Policlinico Agostino Gemelli, Rome, Italy.
Pediatric Intensive and Intermediate Care Department, Sant Joan de Déu University Hospital, Universitat de Barcelona, Esplugues de Llobregat, Spain.
Respir Care. 2019 Oct;64(10):1270-1278. doi: 10.4187/respcare.06608. Epub 2019 Jun 4.
In recent years, respiratory support in severe bronchiolitis has changed in several aspects: increased use of noninvasive ventilation, new equipment, and implementation of high-flow nasal cannula therapy.
To analyze the effectiveness of the changes progressively introduced in the respiratory support of patients with bronchiolitis to reduce the intubation rate.
This was a retrospective, observational, descriptive study. Patients admitted to the pediatric ICU of Hospital Sant Joan de Déu (Barcelona, Spain) with respiratory failure due to bronchiolitis in the 2010-2011 and 2016-2017 periods were included. Exclusion criteria were the following: patients who were previously intubated and tracheostomized and patients > 1 y. Data collected were demographic, clinical, and ventilatory variables, including the type, equipment used, and length of the respiratory support received.
A total of 161 subjects were included: 53 in the 2010-2011 period and 108 in the 2016-2017 period. No clinical differences were observed except the incidence of previous apnea, a diagnosis of sepsis, and procalcitonin values on admission that were higher in the first period. High-flow nasal cannula use before pediatric ICU admission was significantly higher in 2016-2017. A significant increase in the use of the total face mask was observed. The need for invasive ventilation decreased from 37.7% to 17.5%. In the multivariate study, use of interfaces other than the total face mask was identified as the only independent predictive factor for noninvasive ventilation failure, with an odds ratio of 2.5, 95% CI 1.04-6.2 ( = .040).
An important reduction in invasive ventilation was observed. An independent predictive factor for noninvasive ventilation failure was in using an interface other than the total face mask. Implementation of high-flow nasal cannula has not been identified as an independent protective factor for intubation.
近年来，小儿毛细支气管炎的呼吸支持在多个方面发生了变化：无创通气的应用增加、新设备的应用以及高流量鼻导管治疗的应用。
分析在毛细支气管炎患者呼吸支持方面逐步引入的变化，以降低插管率。
这是一项回顾性、观察性、描述性研究。纳入 2010-2011 年和 2016-2017 年期间因毛细支气管炎导致呼吸衰竭而入住西班牙巴塞罗那 Sant Joan de Déu 医院儿科重症监护病房（PICU）的患者。排除标准为：既往插管和气管切开以及＞1 岁的患者。收集的资料包括人口统计学、临床和通气变量，包括所接受的呼吸支持的类型、设备和时间。
共纳入 161 例患者：2010-2011 年期间 53 例，2016-2017 年期间 108 例。除第一个时期的既往呼吸暂停发生率、脓毒症诊断和入院时降钙素原值较高外，两组间无临床差异。2016-2017 年，患儿入 PICU 前使用高流量鼻导管的比例显著增加。总的面罩的使用率显著增加。需要有创通气的患者比例从 37.7%降至 17.5%。在多变量研究中，除了总面罩之外的其他接口的使用被确定为无创通气失败的唯一独立预测因素，比值比为 2.5，95%可信区间为 1.04-6.2（=0.040）。
有创通气显著减少。无创通气失败的独立预测因素是使用总面罩以外的接口。高流量鼻导管的应用并未被确定为插管的独立保护因素。
