Ross Patrick A, Engorn Branden M, Newth Christopher J L, Gordon Chloe, Soto-Campos Gerardo, Bhalla Anoopindar K
Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA.
Department of Pediatrics, Keck School of Medicine of University of Southern California, Los Angeles, CA.
Crit Care Explor. 2021 Mar 5;3(3):e0359. doi: 10.1097/CCE.0000000000000359. eCollection 2021 Mar.
To investigate the change in rate of invasive procedures (endotracheal intubation, central venous catheters, arterial catheters, and peripheral inserted central venous catheters) performed in PICUs per admission over time. Secondarily, to investigate the change in type of respiratory support over time.
Retrospective study of prospectively collected data using the Virtual Pediatric Systems (VPS; LLC, Los Angeles, CA) database.
North American PICUs.
Patients admitted from January 2009 to December 2017.
None.
There were 902,624 admissions from 161 PICUs included in the analysis. Since 2009, there has been a decrease in rate of endotracheal intubations, central venous catheters placed, and arterial catheters placed and an increase in the rate of peripheral inserted central venous catheter insertion per admission over time after controlling for severity of illness and unit level effects. As compared to 2009, the incident rate ratio for 2017 for endotracheal intubation was 0.90 (95% CI, 0.83-0.98; = 0.017), for central venous line placement 0.69 (0.63-0.74; < 0.001), for arterial catheter insertion 0.85 (0.79-0.92; < 0.001), and for peripheral inserted central venous catheter placement 1.14 (1.03-1.26; = 0.013). Over this time period, in a subgroup with available data, there was a decrease in the rate of invasive mechanical ventilation and an increase in the rate of noninvasive respiratory support (bilevel positive airway pressure/continuous positive airway pressure and high-flow nasal oxygen) per admission.
Over 9 years across multiple North American PICUs, the rate of endotracheal intubations, central catheter, and arterial catheter insertions per admission has decreased. The use of invasive mechanical ventilation has decreased with an increase in noninvasive respiratory support. These data support efforts to improve exposure to invasive procedures in training and structured systems to evaluate continued competency.
调查儿科重症监护病房（PICU）每次住院时侵入性操作（气管插管、中心静脉导管、动脉导管和外周静脉穿刺中心静脉导管）的发生率随时间的变化。其次，调查呼吸支持类型随时间的变化。
使用虚拟儿科系统（VPS；LLC，洛杉矶，加利福尼亚州）数据库对前瞻性收集的数据进行回顾性研究。
北美儿科重症监护病房。
2009年1月至2017年12月期间入院的患者。
无。
分析纳入了161个儿科重症监护病房的902,624例住院病例。自2009年以来，在控制疾病严重程度和单位水平影响后，气管插管、中心静脉导管置入和动脉导管置入的发生率有所下降，每次住院外周静脉穿刺中心静脉导管置入的发生率有所上升。与2009年相比，2017年气管插管的发生率比为0.90（95%CI，0.83 - 0.98；P = 0.017），中心静脉置管为0.69（0.63 - 0.74；P < 0.001），动脉导管插入为0.85（0.79 - 0.92；P < 0.001），外周静脉穿刺中心静脉导管置管为1.14（1.03 - 1.26；P = 0.013）。在此期间，在有可用数据的亚组中，每次住院有创机械通气的发生率下降，无创呼吸支持（双水平气道正压/持续气道正压和高流量鼻导管吸氧）的发生率上升。
在北美多个儿科重症监护病房的9年期间，每次住院的气管插管、中心导管和动脉导管插入的发生率有所下降。有创机械通气的使用减少，无创呼吸支持增加。这些数据支持在培训中努力减少侵入性操作的暴露，并建立结构化系统以评估持续能力。
