小儿心脏手术中经鼻双水平气道正压通气与高流量鼻导管作为无创呼吸支持手段的比较
Comparison of Nasal bi-level Positive Airway Pressure Versus High-flow Nasal Cannula as a Means of Noninvasive Respiratory Support in Pediatric Cardiac Surgery.
作者信息
Jayashankar Jessin Puliparambil, Rajan Pinky, Kottayil Brijesh Parayaru, Jayant Aveek, Balachandran Rakhi
机构信息
Department of Cardiac Anaesthesia, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
Division of Respiratory Therapy, Department of Anaesthesia, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
出版信息
Anesth Essays Res. 2020 Apr-Jun;14(2):283-287. doi: 10.4103/aer.AER_39_20. Epub 2020 Oct 12.
BACKGROUND
Noninvasive respiratory support is often used in preventing postextubation respiratory failure in neonates and infants after cardiac surgery.
AIM
We compared the efficacy of nasal Bilevel Positive Airway Pressure (N/BiPAP) with that of High- flow Nasal Cannula(HFNC) in prevention of post extubation respiratory failure and maintenance of gas exchange in neonates and infants undergoing cardiac surgery. The incidence of complications related to the use of these modes were also compared.
SETTINGS AND DESIGN
This is a retrospective review of medical records of patients in pediatric cardiac intensive unit of a high-volume center.
METHODS
A total of 100 patients who received noninvasive respiratory support postextubation were divided into N/BiPAP group and HFNC group. The two groups were compared for postextubation respiratory failure, gas exchange in arterial blood gas at 24 h of extubation, and incidence of complications, namely pneumothorax, abdominal distension, and device-interface-related pressure ulcers.
RESULTS
Fifty patients each received N/BiPAP and HFNC after extubation. Patients who received N/BiPAP were younger (2.68 ± 2.97 months vs. 6.94 ± 4.04 months, = 0.001) and had longer duration of postoperative ventilation (106.98 ± 79.02 h vs. 62.72 ± 46.14 h, = 0.001). The reintubation rates were similar (20% [ = 10] in N/BiPAP group vs. 8% [ = 4] in HFNC group, = 0.074). The mean arterial PO values at 24 h of extubation was 119.17 ± 56.07 mmHg for N/BiPAP group versus 123.32 ± 64.33 mmHg for HFNC group ( = 0.732). Arterial PCO values at 24 h were similar (43.97 ± 43.64 mmHg in N/BiPAP vs. 37.67 ± 4.78 mmHg in HFNC, = 0.318). N/BiPAP group had higher incidence of abdominal distension (16% [ = 8] vs. nil in HFNC group, = 0.003) and interface-related pressure ulcers (86% [ = 43] vs. 14% [ = 7] = 0.006).
CONCLUSION
N/BiPAP and HFNC have comparable efficacy in preventing reintubation and maintaining gas exchange. HFNC has fewer complications compared to N/BiPAP.
背景
无创呼吸支持常用于预防心脏手术后新生儿和婴儿的拔管后呼吸衰竭。
目的
我们比较了经鼻双水平气道正压通气（N/BiPAP）与高流量鼻导管吸氧（HFNC）在预防心脏手术新生儿和婴儿拔管后呼吸衰竭及维持气体交换方面的疗效。还比较了使用这些模式相关并发症的发生率。
设置与设计
这是对一家大型中心儿科心脏重症监护病房患者病历的回顾性研究。
方法
共有100例拔管后接受无创呼吸支持的患者被分为N/BiPAP组和HFNC组。比较两组的拔管后呼吸衰竭情况、拔管后24小时动脉血气中的气体交换情况以及并发症发生率，即气胸、腹胀和与设备接口相关的压疮。
结果
每组各有50例患者在拔管后接受N/BiPAP和HFNC治疗。接受N/BiPAP治疗的患者年龄更小（2.68±2.97个月 vs. 6.94±4.04个月，P = 0.001），术后通气时间更长（106.98±79.02小时 vs. 62.72±46.14小时，P = 0.001）。再插管率相似（N/BiPAP组为20%[n = 10]，HFNC组为8%[n = 4]，P = 0.074）。拔管后24小时N/B/Bi BiPAP组的平均动脉血氧分压值为119.17±56.07 mmHg，而HFNC组为123.32±64.33 mmHg（P = 0.732）。24小时动脉血二氧化碳分压值相似（N/BiPAP组为43.97±43.64 mmHg，HFNC组为37.67±4.78 mmHg，P = 0.318）。N/BiPAP组腹胀发生率更高（16%[n = 8]，而HFNC组无，P = 0.003）以及与接口相关的压疮发生率更高（86%[n = 43] vs. 14%[n = 7]，P = 0.006）。
结论
N/BiPAP和HFNC在预防再插管和维持气体交换方面疗效相当。与N/BiPAP相比，HFNC并发症更少。
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