Pediatric Intensive Care Unit, Arnaud de Villeneuve Hospital, Montpellier University Hospital Centre, Montpellier, France.
Pediatric Functional Exploration Unit, Arnaud de Villeneuve Hospital, Montpellier University Hospital Center, Montpellier, France.
J Pediatr. 2021 Apr;231:239-245.e1. doi: 10.1016/j.jpeds.2020.12.020. Epub 2020 Dec 15.
To assess the inspiratory demand in young infants with acute viral bronchiolitis to provide a physiological basis for initial flow setting for patients supported with high flow nasal cannula.
Prospective study in 44 infants up to 6 months old with acute viral bronchiolitis, admitted to a pediatric intensive care unit from November 2017 to March 2019. Airflow measurements were performed using spirometry. The primary endpoint was the inspiratory demand as measured by peak tidal inspiratory flow (PTIF). The secondary endpoints were the relationships determined between PTIF, patient weight, and disease severity.
Median (Q-Q) age and weight of the patients were 37 (20-67) days and 4.3 (3.5-5.0) kg, respectively. Mean PTIF was 7.45 (95% CI 6.51-8.39, min-max: 2.40-16.00) L/minute. PTIF indexed to weight was 1.68 (95% CI 1.51-1.85, min-max: 0.67-3.00) L/kg/minute. PTIF was <2.5 L/kg/minute in 89% (95% CI 75-96) of infants. PTIF was correlated with weight (ρ= 0 .55, P < .001) but not with markers of disease severity, including modified Woods clinical asthma score, Silverman-Andersen score, respiratory rate, fraction of inspired oxygen, and PCO.
High flow nasal cannula therapy is used commonly to support infants with acute viral bronchiolitis. The efficiency of the device is optimal if the flow setting matches the patient's inspiratory demand. According to our results, a flow rate of <2.5 L/kg/minute would be appropriate in most situations.
评估急性病毒性细支气管炎婴儿的吸气需求，为高流量鼻导管支持的患者初始流量设置提供生理基础。
2017 年 11 月至 2019 年 3 月，对 44 名 6 个月以下急性病毒性细支气管炎婴儿进行前瞻性研究。使用肺活量计进行气流测量。主要终点是通过峰潮吸气流速（PTIF）测量的吸气需求。次要终点是 PTIF 与患者体重和疾病严重程度之间的关系。
患者的中位（Q-Q）年龄和体重分别为 37（20-67）天和 4.3（3.5-5.0）kg。平均 PTIF 为 7.45（95%可信区间 6.51-8.39，最小值-最大值：2.40-16.00）L/分钟。体重校正的 PTIF 为 1.68（95%可信区间 1.51-1.85，最小值-最大值：0.67-3.00）L/kg/分钟。89%（95%可信区间 75-96）的婴儿的 PTIF ＜2.5 L/kg/分钟。PTIF 与体重相关（ρ=0.55，P＜0.001），但与疾病严重程度标志物（包括改良 Woods 临床哮喘评分、Silverman-Andersen 评分、呼吸频率、吸入氧分数和 PCO）无关。
高流量鼻导管治疗常用于支持急性病毒性细支气管炎婴儿。如果流量设置与患者的吸气需求相匹配，设备的效率最佳。根据我们的结果，在大多数情况下，流速＜2.5 L/kg/分钟是合适的。
