White Deborah K, Daubney Esther S, Harvey Mark E, Kayani Riaz, Pathan Nazima
Paediatric Intensive Care Unit, Cambridge University Hospitals NHS Foundation Trust, Box 7, Addenbrooke's Hospital, Cambridge, UK.
Department of Paediatrics, Cambridge University, Box 116, Addenbrooke's Hospital, Cambridge, UK.
Nurs Crit Care. 2021 Jan;26(1):42-47. doi: 10.1111/nicc.12509. Epub 2020 Apr 14.
High-flow nasal cannula (HFNC) therapy is widely used for respiratory support within paediatrics, most commonly used as a supportive measure in acute respiratory failure, aiming to avoid invasive mechanical ventilation (IMV). It is increasingly being used following extubation of critically ill children potentially at a higher risk of requiring re-intubation. Less data indicate the use for post-extubation HFNC therapy or possible clinical outcomes of this therapy.
To identify reasons for, and variables to predict, the use of HFNC therapy post-extubation.
This was a retrospective case-control study.
All children admitted to a nine-bedded regional paediatric intensive care unit requiring IMV between 18 December 2017 and 28 November 2018 were identified. The demographic data and bedside clinical and laboratory variables of the patients requiring HFNC therapy were compared with those who did not require HFNC.
There was no statistical difference in the median age and weight of children receiving HFNC therapy post-extubation compared with children not receiving it. In a logistic regression model, the highest ventilation (peak inspiratory pressure) and oxygen requirements in the first 24 hours of admission, along with the presence of comorbidity and use of HFNC therapy prior to intubation, predicted the use of HFNC following extubation, (r 0.42, area under the receiver operating curve 0.843, P < .0001).
The direct correlation between high initial ventilatory requirements and pre-existing comorbidity was significant for the use of post-extubation HFNC therapy. This may be useful to stratify children in the use of HFNC therapy post-extubation in the critically ill population.
This study provides evidence that it may be possible to predict the use of HFNC therapy post-extubation. Avoiding unnecessary use of this therapy improves patient care while providing a positive economic impact.
高流量鼻导管（HFNC）治疗在儿科呼吸支持中广泛应用，最常用于急性呼吸衰竭的支持性措施，旨在避免有创机械通气（IMV）。越来越多地用于对危重症儿童拔管后，这些儿童可能有更高的再次插管风险。关于拔管后HFNC治疗的应用或该治疗可能的临床结局的数据较少。
确定拔管后使用HFNC治疗的原因及预测变量。
这是一项回顾性病例对照研究。
确定2017年12月18日至2018年11月28日期间入住有9张床位的地区儿科重症监护病房且需要IMV的所有儿童。将需要HFNC治疗的患者的人口统计学数据、床边临床和实验室变量与不需要HFNC的患者进行比较。
拔管后接受HFNC治疗的儿童与未接受HFNC治疗的儿童在年龄中位数和体重方面无统计学差异。在逻辑回归模型中，入院后最初24小时内最高通气量（吸气峰压）和氧气需求量，以及合并症的存在和插管前使用HFNC治疗，可预测拔管后HFNC的使用（r = 0.42，受试者工作特征曲线下面积为0.843，P < 0.0001）。
初始通气需求高与既有合并症之间的直接关联对于拔管后HFNC治疗的使用具有重要意义。这可能有助于在危重症人群中对拔管后使用HFNC治疗的儿童进行分层。
本研究提供了证据表明有可能预测拔管后HFNC治疗的使用。避免不必要地使用该治疗可改善患者护理，同时产生积极的经济影响。
