Soshnick Sara H, Carroll Christopher L, Cowl Allison S
Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children's Hospital at Montefiore, Bronx, NY.
Division of Pediatric Critical Care Medicine, Department of Pediatrics, Connecticut Children's Medical Center, Hartford, CT.
Crit Care Explor. 2019 Aug 1;1(8):e0026. doi: 10.1097/CCE.0000000000000026. eCollection 2019 Aug.
To assess how a change in practice to more frequent use of high-flow nasal cannula for the treatment of bronchiolitis would affect the use of invasive devices in children.
Retrospective cohort study of children under 2 years old admitted to the ICU with respiratory failure secondary to bronchiolitis. Outcomes and invasive device use were compared between two time periods, before and after the practice change.
Eighteen bed tertiary care PICU.
A total of 325 children: 146 from 2010 to 2012 and 179 from 2015 to 2016.
None.
There were no significant differences between the two time periods regarding gender, race/ethnicity, medical history, and viral profile, although children were younger in the earlier cohort (median age of 1.9 mo [interquartile range, 1.2-3.5] vs 3.3 mo [1.7-8.6]; < 0.001). There was an increased use of noninvasive ventilation in the second time period (94% from 69%; < 0.001), as well as a decreased frequency of intubation (13% from 42%; < 0.001) and reduced central venous catheter placement (7% from 37%; < 0.001). There was no significant difference in mortality between the two groups. A logistic regression analysis was conducted, which found that time period, intubation, and hospital length of stay were all independently associated with central venous catheter placement.
A practice change toward managing patients with bronchiolitis in respiratory failure with less invasive means was associated with a reduction in the use of other invasive devices. In our cohort, minimizing the use of invasive ventilation and devices was not associated with an increase in mortality and could potentially have additional benefits.
评估在治疗细支气管炎时，改变治疗方式以更频繁地使用高流量鼻导管会如何影响儿童侵入性设备的使用情况。
对因细支气管炎继发呼吸衰竭而入住重症监护病房（ICU）的2岁以下儿童进行回顾性队列研究。比较了实践改变前后两个时间段的结果和侵入性设备使用情况。
拥有18张床位的三级护理儿科重症监护病房。
共325名儿童，2010年至2012年有146名，2015年至2016年有179名。
无。
两个时间段在性别、种族/民族、病史和病毒谱方面无显著差异，不过早期队列中的儿童年龄更小（中位年龄1.9个月[四分位间距，1.2 - 3.5]对比3.3个月[1.7 - 8.6]；<0.001）。第二个时间段无创通气的使用有所增加（从69%增至94%；<0.001），插管频率降低（从42%降至13%；<0.001），中心静脉导管置入减少（从37%降至7%；<0.001）。两组死亡率无显著差异。进行了逻辑回归分析，发现时间段、插管情况和住院时长均与中心静脉导管置入独立相关。
在管理呼吸衰竭的细支气管炎患者时，采用侵入性较小的方法进行实践改变与其他侵入性设备使用的减少相关。在我们的队列中，尽量减少侵入性通气和设备的使用与死亡率增加无关，且可能有额外益处。
