Department of Respiratory Care, Boston Children's Hospital, Boston Massachusetts.
Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, as well as the Harvard Medical School, Boston, Massachusetts.
Respir Care. 2020 Nov;65(11):1631-1640. doi: 10.4187/respcare.07600. Epub 2020 Jun 16.
High-frequency jet ventilation (HFJV) has been used in conjunction with conventional ventilation for premature infants with respiratory failure. We sought to identify parameters that were associated with mortality in subjects who underwent HFJV.
Subjects were enrolled if birthweight was ≤ 2,000 g and they were ≤ 34 weeks gestational age. Subjects were excluded if they received HFJV at the time of admission because we aimed to study subjects who failed conventional ventilation. Subject demographics, ventilator parameters, and laboratory data were extracted and analyzed. The Mann-Whitney -test was used to assess differences in continuous variables, and the chi-square and Fisher exact tests were used for categorical variables between the groups. To assess variables that were predictive of mortality, we used both univariate and multivariate logistic regression analysis. Independent predictors of mortality were identified and used to create a multivariate risk score. Receiver operating characteristic curves were constructed to evaluate the predictive accuracy of the multivariate risk score.
A total of 53 premature subjects ( = 37 male) were studied, of whom 39 (74%) survived to discharge or transfer back to referring hospital. In the univariate model, female sex, older gestational age, higher birthweight, HFJV peak inspiratory pressure at 1 h, and oxygen saturation index at 4 h were associated with mortality. In the final multivariate logistic regression model, female sex (odds ratio 4.1, 95% CI 1.2-19.8, = .044), closed ductus arteriosus (odds ratio 7.7, 95% CI 1.3-39.5, = .016), and oxygen saturation index > 5.5 (odds ratio 6.0, 95% CI 1.5-28.3, = .02) were independent predictors of mortality.
We identified that oxygen saturation index > 5.5 after 4 h of HFJV, female sex, and closed ductus arteriosus were independent predictors of mortality.
高频喷射通气（HFJV）已与常规通气联合应用于患有呼吸衰竭的早产儿。我们试图确定与接受 HFJV 的受试者死亡率相关的参数。
如果出生体重≤2000 克且胎龄≤34 周，则纳入受试者。如果他们在入院时接受 HFJV，则将其排除在外，因为我们旨在研究常规通气失败的受试者。提取并分析受试者的人口统计学、呼吸机参数和实验室数据。使用 Mann-Whitney U 检验评估组间连续变量的差异，使用卡方和 Fisher 确切检验评估分类变量的差异。为了评估预测死亡率的变量，我们同时使用单变量和多变量逻辑回归分析。确定死亡率的独立预测因素，并用于创建多变量风险评分。构建受试者工作特征曲线以评估多变量风险评分的预测准确性。
共研究了 53 名早产儿（=37 名男性），其中 39 名（74%）存活至出院或转回转诊医院。在单变量模型中，女性、较大的胎龄、较高的出生体重、HFJV 通气 1 小时的峰压和通气 4 小时的氧饱和度指数与死亡率相关。在最终的多变量逻辑回归模型中，女性（比值比 4.1，95%置信区间 1.2-19.8，=.044）、动脉导管未闭（比值比 7.7，95%置信区间 1.3-39.5，=.016）和氧饱和度指数>5.5（比值比 6.0，95%置信区间 1.5-28.3，=.02）是死亡率的独立预测因素。
我们确定，HFJV 通气 4 小时后氧饱和度指数>5.5、女性和动脉导管未闭是死亡率的独立预测因素。
