Department of Pediatrics, Boston Children's Hospital, Boston, MA.
Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA.
Pediatr Crit Care Med. 2020 Dec;21(12):e1152-e1156. doi: 10.1097/PCC.0000000000002457.
To determine the prevalence of adverse events during apnea testing for determination of death by neurologic criteria using continuous positive airway pressure in children.
Single-center retrospective descriptive study.
Academic children's hospital.
Children evaluated for death by neurologic criteria in the PICU from 2013 to 2018.
None.
For each patient evaluated for death by neurologic criteria, we abstracted the number of apnea tests performed, vital signs and arterial blood gases during apnea testing, and outcome from the medical record. Adverse events were defined as oxygen-hemoglobin desaturation (arterial oxygen saturation < 85%), hypotension, or other significant event (e.g. arrhythmia, cardiac arrest) based on documentation in the medical record. We determined which adverse events resulted in early termination of the apnea test. We used oxygenation index, ventilator variables, and presence of vasopressors to determine preapnea test cardiopulmonary dysfunction. Seventy-two patients (age 7 yr [2.7-13.2 yr]; 48% male) underwent 121 apnea tests. Nine patients (12%) had 13 potential apnea tests deferred due to concern for cardiopulmonary instability as determined by the attending physician. Patients who underwent apnea testing had an oxygenation index of 3.5 (2.5-4.8) and were receiving vasopressors at the time of 108 apnea tests (89%). Hypotension was reported during seven apnea tests (6%) and resulted in the early termination of one apnea test (<1%). No other adverse events were reported. One hundred and twenty apnea tests (99%) were consistent with death by neurologic criteria.
Apnea testing following a protocol that uses continuous positive airway pressure for apneic oxygenation has a low rate of adverse events in children meeting prerequisite criteria and determined by a pediatric intensivist to be physiologically appropriate for testing.
确定在儿科重症监护病房（PICU）使用持续气道正压通气（CPAP）进行神经学标准确定的死亡时，进行呼吸暂停试验期间发生不良事件的发生率。
单中心回顾性描述性研究。
学术儿童医院。
2013 年至 2018 年在 PICU 中因神经学标准评估死亡的儿童。
无。
对于每个因神经学标准评估死亡的患者，我们从病历中提取了进行的呼吸暂停试验次数、呼吸暂停试验期间的生命体征和动脉血气值以及结果。不良事件定义为氧合血红蛋白下降（动脉血氧饱和度 < 85%）、低血压或其他重大事件（例如心律失常、心脏骤停），依据病历中的记录。我们确定了哪些不良事件导致呼吸暂停试验提前终止。我们使用氧合指数、呼吸机变量和血管加压素的存在来确定呼吸暂停试验前心肺功能障碍。72 名患者（年龄 7 岁[2.7-13.2 岁]；48%为男性）接受了 121 次呼吸暂停试验。9 名患者（12%）因心肺不稳定而推迟了 13 次可能的呼吸暂停试验，这是由主治医生确定的。接受呼吸暂停试验的患者氧合指数为 3.5（2.5-4.8），在 108 次呼吸暂停试验中（89%）正在接受血管加压素治疗。在 7 次呼吸暂停试验中（6%）报告了低血压，并导致 1 次呼吸暂停试验提前终止（<1%）。未报告其他不良事件。120 次呼吸暂停试验（99%）与神经学标准确定的死亡一致。
在儿科重症监护病房（PICU）使用持续气道正压通气（CPAP）进行呼吸暂停氧合的方案中，符合先决条件标准且被儿科重症监护医师认为生理上适合进行试验的儿童发生呼吸暂停试验的不良事件发生率较低。
