Al-Hadidi Ameer, Lapkus Morta, Karabon Patrick, Akay Begum, Khandhar Paras
Beaumont Health, Royal Oak, MI, USA.
Oakland University William Beaumont School of Medicine, Rochester, MI, USA.
Glob Pediatr Health. 2021 Jan 27;8:2333794X21991531. doi: 10.1177/2333794X21991531. eCollection 2021.
Post-extubation respiratory failure requiring reintubation in a Pediatric Intensive Care Unit (PICU) results in significant morbidity. Data in the pediatric population comparing various therapeutic respiratory modalities for avoiding reintubation is lacking. Our objective was to compare therapeutic respiratory modalities following extubation from mechanical ventilation. About 491 children admitted to a single-center PICU requiring mechanical ventilation from January 2010 through December 2017 were retrospectively reviewed. Therapeutic respiratory support assisted in avoiding reintubation in the majority of patients initially extubated to room air or nasal cannula with high-flow nasal cannula (80%) or noninvasive positive pressure ventilation (100%). Patients requiring therapeutic respiratory support had longer PICU LOS (10.92 vs 6.91 days, -value = .0357) and hospital LOS (16.43 vs 10.20 days, -value = .0250). Therapeutic respiratory support following extubation can assist in avoiding reintubation. Those who required therapeutic respiratory support experienced a significantly longer PICU and hospital LOS. Further prospective clinical trials are warranted.
在儿科重症监护病房（PICU）中，拔管后呼吸衰竭需要重新插管会导致显著的发病率。儿科人群中缺乏比较各种治疗性呼吸模式以避免重新插管的数据。我们的目的是比较机械通气拔管后的治疗性呼吸模式。回顾性分析了2010年1月至2017年12月期间入住单中心PICU需要机械通气的约491名儿童。对于大多数最初拔管至室内空气或鼻导管的患者，采用高流量鼻导管（80%）或无创正压通气（100%）的治疗性呼吸支持有助于避免重新插管。需要治疗性呼吸支持的患者在PICU的住院时间更长（10.92天对6.91天，P值 = 0.0357），在医院的住院时间也更长（16.43天对10.20天，P值 = 0.0250）。拔管后的治疗性呼吸支持有助于避免重新插管。那些需要治疗性呼吸支持的患者在PICU和医院的住院时间显著更长。有必要进行进一步的前瞻性临床试验。
