Division of Critical Care Medicine, 12334Children's National Health System, Washington, DC, USA.
Division of Pulmonology, 12334Children's National Health System, Washington, DC, USA.
J Intensive Care Med. 2022 Jan;37(1):120-127. doi: 10.1177/0885066620979642. Epub 2021 Jan 8.
In infants hospitalized for bronchiolitis on non-invasive ventilation (NIV) via the RAM cannula nasal interface, variables predicting subsequent intubation, or NIV non-response, are understudied. We sought to identify predictors of NIV non-response.
We performed a retrospective cohort study in infants admitted for respiratory failure from bronchiolitis placed on NIV in a quaternary children's hospital. We excluded children with concurrent sepsis, critical congenital heart disease, or with preexisting tracheostomy. The primary outcome was NIV non-response defined as intubation after a trial of NIV. Secondary outcomes were vital sign values before and after NIV initiation, duration of NIV and intubation, and mortality. Primary analyses included Chi-square, Wilcoxon rank-sum, student's test, paired analyses, and adjusted and unadjusted logistic regression assessing heart rate (HR) and respiratory rate (RR) before and after NIV initiation.
Of 138 infants studied, 34% were non-responders. There were no differences in baseline characteristics of responders and non-responders. HR decreased after NIV initiation in responders (156 [143-156] to149 [141-158], < 0.01) compared to non-responders (158 [149-166] to 158 [145-171], = 0.73). RR decreased in responders (50 [43-58] vs 47 [41-54]) and non-responders (52 [48-58] vs 51 [40-55], both < 0.01). Concurrent bacterial pneumonia (OR 6.06, 95% CI: 2.54-14.51) and persistently elevated HR (OR: 1.04, 95% CI: 1.01-1.07) were associated with NIV non-response.
In children with acute bronchiolitis who fail to respond to NIV and require subsequent intubation, we noted associations with persistently elevated HR after NIV initiation and concurrent bacterial pneumonia.
在因毛细支气管炎而通过 RAM 管鼻内接口接受无创通气（NIV）治疗的住院婴儿中，预测随后插管或 NIV 无反应的变量研究不足。我们试图确定 NIV 无反应的预测因素。
我们对一家四级儿童医院因呼吸衰竭接受 NIV 治疗的毛细支气管炎住院婴儿进行了回顾性队列研究。我们排除了并发脓毒症、严重先天性心脏病或存在先前气管造口术的儿童。主要结局是 NIV 无反应，定义为 NIV 试验后插管。次要结局是 NIV 前后的生命体征值、NIV 和插管的持续时间以及死亡率。主要分析包括卡方检验、Wilcoxon 秩和检验、学生 t 检验、配对分析以及调整和未调整的逻辑回归分析，评估 NIV 前后的心率（HR）和呼吸频率（RR）。
在研究的 138 名婴儿中，34%为无反应者。反应者和无反应者的基线特征无差异。反应者在接受 NIV 后 HR 下降（156[143-156]至 149[141-158]，<0.01），而无反应者 HR 无变化（158[149-166]至 158[145-171]，=0.73）。反应者 RR 下降（50[43-58]与 47[41-54]，<0.01），无反应者 RR 也下降（52[48-58]与 51[40-55]，均<0.01）。同时患有细菌性肺炎（OR 6.06，95%CI：2.54-14.51）和持续升高的 HR（OR：1.04，95%CI：1.01-1.07）与 NIV 无反应相关。
在急性毛细支气管炎且对 NIV 无反应并需要后续插管的儿童中，我们注意到与 NIV 后 HR 持续升高和同时患有细菌性肺炎有关。
