Department of Pediatrics, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health, Indianapolis, IN.
Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health, Indianapolis, IN.
Pediatr Crit Care Med. 2020 Dec;21(12):e1069-e1075. doi: 10.1097/PCC.0000000000002520.
High-flow nasal cannula and noninvasive positive pressure ventilation have become ubiquitous in contemporary PICUs. Practice patterns associated with the use of these modalities have not been well described. In this study, we aimed to describe the use of high-flow nasal cannula and noninvasive positive pressure ventilation in children after extubation and analyze the progression of usage in association with patient factors. Our secondary aim was to describe interventions used for postextubation stridor.
Single-center retrospective cohort study.
A 36-bed quaternary medical-surgical PICU.
Mechanically ventilated pediatric patients admitted between April 2017 and March 2018. Exclusions were patients in the cardiac ICU, patients requiring a tracheostomy or chronic ventilatory support, and patients with limited resuscitation status.
None.
Data regarding respiratory modality use was collected for the first 72 hours after extubation. There were 427 patients included in the analysis; 51 patients (11.9%) were extubated to room air, 221 (51.8%) to nasal cannula, 132 (30.9%) to high-flow nasal cannula, and 23 (5.4%) to noninvasive positive pressure ventilation. By 72 hours, 314 patients (73.5%) were on room air, 52 (12.2%) on nasal cannula, 29 (6.8%) on high-flow nasal cannula, eight (1.9%) on noninvasive positive pressure ventilation, and 24 (5.6%) were reintubated. High-flow nasal cannula was the most used respiratory modality for postextubation stridor. Multivariate analysis demonstrated that longer duration of invasive mechanical ventilation increased the odds of initial high-flow nasal cannula and noninvasive positive pressure ventilation use, and a diagnosis of cerebral palsy increased the odds of escalating from high-flow nasal cannula to noninvasive positive pressure ventilation in the first 24 hours post extubation.
High-flow nasal cannula is commonly used immediately after pediatric extubation and the development of postextubation stridor; however, its usage sharply declines over the following 72 hours. Larger multicenter trials are needed to identify high-risk patients for extubation failure that might benefit the most from prophylactic use of high-flow nasal cannula and noninvasive positive pressure ventilation after extubation.
高流量鼻导管和无创正压通气已在当代儿科重症监护病房（PICU）中广泛应用。然而，这些治疗方式的应用模式尚未得到充分描述。本研究旨在描述拔管后儿童使用高流量鼻导管和无创正压通气的情况，并分析与患者因素相关的使用进展。我们的次要目的是描述拔管后喘鸣的干预措施。
单中心回顾性队列研究。
一家 36 床的四级综合外科 PICU。
2017 年 4 月至 2018 年 3 月期间接受机械通气的儿科患者。排除标准为心脏 ICU 患者、需要气管切开或慢性通气支持的患者以及复苏状态有限的患者。
无。
收集拔管后 72 小时内的呼吸方式使用数据。共纳入 427 例患者，其中 51 例（11.9%）患者被拔管至空气，221 例（51.8%）患者被拔管至鼻导管，132 例（30.9%）患者被拔管至高流量鼻导管，23 例（5.4%）患者被拔管至无创正压通气。72 小时时，314 例（73.5%）患者在空气，52 例（12.2%）患者在鼻导管，29 例（6.8%）患者在高流量鼻导管，8 例（1.9%）患者在无创正压通气，24 例（5.6%）患者重新插管。高流量鼻导管是拔管后喘鸣最常用的呼吸方式。多变量分析表明，侵入性机械通气时间延长会增加初始使用高流量鼻导管和无创正压通气的可能性，脑瘫诊断会增加在拔管后 24 小时内从高流量鼻导管升级为无创正压通气的可能性。
高流量鼻导管在儿科患者拔管后立即被广泛应用于治疗拔管后喘鸣；然而，在随后的 72 小时内，其使用率急剧下降。需要更大规模的多中心试验来确定拔管失败的高危患者，这些患者可能从拔管后预防性使用高流量鼻导管和无创正压通气中获益最大。
