University of South Florida, Tampa, FL, USA.
Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA.
J Asthma. 2022 Apr;59(4):757-764. doi: 10.1080/02770903.2021.1872085. Epub 2021 Jan 15.
We aimed to describe patient characteristics and clinical outcomes for children hospitalized for status asthmaticus (SA) receiving high-flow nasal cannula (HFNC) or bilevel positive airway pressure (BiPAP).
We performed a single center, retrospective cohort study among 39 children admitted for SA aged 5-17 years from January 2016 to May 2019 to a quaternary pediatric intensive care unit (PICU). Cohorts were defined by BiPAP versus HFNC exposure and assessed to determine if differences existed in demographics, anthropometrics, comorbidities, asthma severity indices, historical factors, duration of noninvasive ventilation, and asthma-related clinical outcomes (i.e. length of stay, mechanical ventilation rates, exposure to concurrent sedatives/anxiolysis, and rate of adjunctive therapy exposure).
Thirty-three percent ( = 13) received HFNC (33%) and 67% ( = 26) BiPAP. Children receiving BiPAP had greater age (10.9 ± 3.7 vs. 6.8 ± 2.2 years, < 0.01), asthma severity (proportion with severe NHLBI classification: 38% vs. 0%, < 0.01; median pediatric asthma severity score: 13[12,14] vs. 10[9,12], < 0.01), previous PICU admissions (62% vs. 15%, = 0.01), frequency of prescribed anxiolysis/sedation (42% vs. 8%, = 0.02), and median duration of continuous albuterol (1.7[1,3.1] vs. 0.9[0.7,1.6] days, = 0.03) compared to those on HFNC. Those on HFNC more commonly were treated comorbid bacterial pneumonia (69% vs. 19%, < 0.01). No differences in NIV duration, mortality, mechanical ventilation rates, or LOS were observed.
Our data suggest a trial of BiPAP or HFNC appears well tolerated in children with SA. Prospective trials are needed to establish modality superiority and identify patient or clinical characteristics that prompt use of HFNC over BiPAP.
本研究旨在描述因哮喘持续状态（SA）住院并接受高流量鼻导管（HFNC）或双水平气道正压通气（BiPAP）治疗的儿童的患者特征和临床结局。
我们对 2016 年 1 月至 2019 年 5 月在一家四级儿科重症监护病房（PICU）住院的年龄为 5-17 岁的 39 名 SA 患儿进行了单中心回顾性队列研究。通过 BiPAP 与 HFNC 暴露来定义队列，并评估是否存在人口统计学、人体测量学、合并症、哮喘严重程度指数、既往因素、无创通气时间以及与哮喘相关的临床结局（即住院时间、机械通气率、同时使用镇静/焦虑药物的情况以及辅助治疗的使用情况）方面的差异。
33%（ = 13）的患儿接受了 HFNC（33%），67%（ = 26）的患儿接受了 BiPAP。接受 BiPAP 的患儿年龄更大（10.9 ± 3.7 岁 vs. 6.8 ± 2.2 岁， < 0.01），哮喘严重程度更高（严重 NHLBI 分级比例：38% vs. 0%， < 0.01；儿科哮喘严重程度评分中位数：13[12,14] vs. 10[9,12]， < 0.01），既往 PICU 入院率更高（62% vs. 15%， = 0.01），镇静/焦虑药物使用频率更高（42% vs. 8%， = 0.02），持续使用沙丁胺醇的中位时间更长（1.7[1,3.1]天 vs. 0.9[0.7,1.6]天， = 0.03），而 HFNC 组则较少。HFNC 组更常见合并细菌性肺炎（69% vs. 19%， < 0.01）。两组间无创通气时间、死亡率、机械通气率或住院时间均无差异。
我们的数据表明，在患有哮喘持续状态的儿童中，使用 BiPAP 或 HFNC 似乎都能很好地耐受。需要前瞻性试验来确定哪种模式更具优势，并确定提示使用 HFNC 而不是 BiPAP 的患者或临床特征。
