一项关于无创通气程序效率的多中心研究（SAFE-NIV）。
A multicentered study on efficiency of noninvasive ventilation procedures (SAFE-NIV).
作者信息
Ongun Ebru Atike, Dursun Oğuz, Anıl Ayşe Berna, Altuğ Ümit, Temel Köksoy Özlem, Akyıldız Başak Nur, Özsoylu Serkan, Kendirli Tanıl, Özcan Serhan, Yıldızdaş Rıza Dinçer, Tolunay İlknur, Karapınar Bülent, Kılınç Mehmet Arda, Demirkol Demet
机构信息
Department of Pediatrics, Division of Pediatric Critical Care, Faculty of Medicine, Akdeniz University Antalya, Turkey
Department of Pediatrics, Division of Pediatric Critical Care, Faculty of Medicine, İzmir Katip Celebi University and Tepecik Research and Training Hospital, İzmir, Turkey
出版信息
Turk J Med Sci. 2021 Jun 28;51(3):1159-1171. doi: 10.3906/sag-2004-35.
BACKGROUND/AIM: To characterize the clinical course of noninvasive positive pressure ventilation (NIPPV) and high flow humidified nasal cannula ventilation (HFNC) procedures; perform risk analysis for ventilation failure.
MATERIAL AND METHODS
This prospective, multi-centered, observational study was conducted in 352 PICU admissions (1 month-18 years) between 2016 and 2017. SPSS-22 was used to assess clinical data, define thresholds for ventilation parameters and perform risk analysis.
RESULTS
Patient age, onset of disease, previous intubation and hypoxia influenced the choice of therapy mode: NIPPV was preferred in older children (p = 0.002) with longer intubation (p < 0.001), ARDS (p = 0.001), lower respiratory tract infections (p < 0.001), chronic respiratory disease, (p = 0.005), malignancy (p = 0.048) and immune deficiency (p = 0.026). The failure rate was 13.4%. sepsis, ARDS, prolonged intubation, and use of nasal masks were associated with NIV failure (p = 0.001, p < 0.001, p < 0.001, p = 0.025). The call of intubation or re-intubation was given due to respiratory failure in twenty-seven (57.5%), hemodynamic instability in eight (17%), bulbar dysfunction or aspiration in 5 (10.6%), neurological deterioration in 4 (8.5%) and developing ARDS in 3 (6.4%) children. A reduction of less than 10% in the respiration within an hour increased the odds of failure by 9.841 times (OR: 9.841, 95% CI: 2.0021–48.3742). FiO2 > 55% at 6th hours and PRISM-3 >8 were other failure predictors. Of the 9.9% complication rate, the most common complication was pressure ulcerations (4.8%) and mainly observed when using full-face masks (p = 0.047). Fifteen (4.3%) patients died of miscellaneous causes. Tracheostomy cannulation was performed on 16 children due to prolonged mechanical ventilation (8% in NIPPV, 2.6% in HFNC)
CONCLUSION
Absence of reduction in the respiration rate within an hour, FiO2 requirement >55% at 6th hours and PRISM-3 score >8 predict NIV failure.
背景/目的：描述无创正压通气（NIPPV）和高流量鼻导管湿化通气（HFNC）的临床过程；进行通气失败的风险分析。
材料与方法
本前瞻性、多中心观察性研究于2016年至2017年对352例入住儿科重症监护病房（年龄1个月至18岁）的患儿进行。使用SPSS - 22评估临床数据，确定通气参数阈值并进行风险分析。
结果
患者年龄、疾病发作、既往插管史和缺氧情况影响治疗模式的选择：年龄较大的儿童（p = 0.002）、插管时间较长（p < 0.001）、急性呼吸窘迫综合征（ARDS，p = 0.001）、下呼吸道感染（p < 0.001）、慢性呼吸道疾病（p = 0.005）、恶性肿瘤（p = 0.048）和免疫缺陷（p = 0.026）的患儿更倾向于选择NIPPV。失败率为13.4%。脓毒症、ARDS、长时间插管和使用鼻面罩与无创通气失败相关（p = 0.001、p < 0.001、p < 0.001、p = 0.025）。27例（57.5%）患儿因呼吸衰竭进行气管插管或再次插管，8例（17%）因血流动力学不稳定，5例（10.6%）因球部功能障碍或误吸，4例（8.5%）因神经功能恶化，3例（6.4%）因发生ARDS。1小时内呼吸频率下降不到10%会使失败几率增加9.841倍（比值比：9.841，95%置信区间：2.0021 - 48.3742）。第6小时的吸氧浓度（FiO2）> 55%和小儿死亡风险评分（PRISM - 3）> 8是其他失败预测因素。并发症发生率为9.9%，最常见的并发症是压疮（4.8%），主要在使用全面罩时观察到（p = 0.047）。15例（4.3%）患者死于其他原因。16例儿童因机械通气时间延长进行了气管切开插管（NIPPV组为8%，HFNC组为2.6%）。
结论
1小时内呼吸频率无下降、第6小时FiO2需求> 55%以及PRISM - 3评分> 8可预测无创通气失败。
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