Department of Pediatrics, University of South Florida College of Medicine, Tampa, FL, USA.
Departmnet of Pediatrics, Johns Hopkins University School of Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA.
Paediatr Anaesth. 2021 Dec;31(12):1340-1349. doi: 10.1111/pan.14295. Epub 2021 Sep 24.
Volatile anesthetic agents are described as rescue therapy for children invasively ventilated for critical asthma. Yet, data are currently limited to case series.
Using the Virtual Pediatric Systems database, we assessed children admitted to a pediatric intensive care unit invasively ventilated for life-threatening asthma and hypothesized ventilation duration and mortality rates would be lower for subjects exposed to volatile anesthetics compared with those without exposure.
We performed a multicenter retrospective cohort study among nine institutions including children 5-17 years of age invasively ventilated for asthma from 2013 to 2019 with and without exposure to volatile anesthetics. Primary outcomes were ventilation duration and mortality. Secondary outcomes included patient characteristics, length of stay, and anesthetic-related adverse events. A subgroup analysis was performed evaluating children intubated ≥2 days.
Of 203 children included in study, there were 29 (14.3%) with and 174 (85.7%) without exposure to volatiles. No differences in odds of mortality (1.1, 95% CI: 0.3-3.9, p > .999) were observed. Subjects receiving volatiles experienced greater median difference in length of stay (4.8, 95% CI: 1.9-7.8 days, p < .001), ventilation duration (2.3, 95% CI: 1-3.3 days, p < .001), and odds of extracorporeal life support (9.1, 95% CI: 1.9-43.2, p = .009) than those without volatile exposure. For those ventilated ≥2 days, no differences were detected in mortality, ventilation duration, length of stay, arrhythmias, or acute renal failure. However, the odds of extracorporeal life support remained greater for those receiving volatiles (7.6, 95% CI: 1.3-44.5, p = .027). No children experienced malignant hyperthermia or hepatic failure after volatile exposure.
For intubated children for asthma, no differences in mechanical ventilation duration or mortality between those with and without volatile anesthetic exposure were observed. Although volatiles may represent a viable rescue therapy for severe cases of asthma, definitive, and prospective trials are still needed.
挥发性麻醉剂被描述为儿童严重哮喘有创通气的抢救治疗方法。然而，目前的数据仅限于病例系列。
使用虚拟儿科系统数据库，我们评估了因危及生命的哮喘而在儿科重症监护病房接受有创通气的儿童，并假设与未暴露于挥发性麻醉剂的儿童相比，接受挥发性麻醉剂的儿童通气时间和死亡率会更低。
我们在包括 9 个机构在内的多中心回顾性队列研究中，评估了 2013 年至 2019 年间因哮喘接受有创通气的 5-17 岁儿童，他们有无接受挥发性麻醉剂。主要结局是通气时间和死亡率。次要结局包括患者特征、住院时间和与麻醉相关的不良事件。进行了亚组分析，评估了插管时间≥2 天的儿童。
在纳入研究的 203 名儿童中，有 29 名（14.3%）和 174 名（85.7%）接受了或未接受挥发性麻醉剂。观察到死亡率的几率无差异（1.1，95%CI：0.3-3.9，p>.999）。接受挥发性麻醉剂的儿童在住院时间（4.8，95%CI：1.9-7.8 天，p<.001）、通气时间（2.3，95%CI：1-3.3 天，p<.001）和体外生命支持的几率（9.1，95%CI：1.9-43.2，p=0.009）方面的中位数差异较大。对于通气时间≥2 天的儿童，在死亡率、通气时间、住院时间、心律失常或急性肾功能衰竭方面没有差异。然而，接受挥发性麻醉剂的儿童接受体外生命支持的几率仍然较高（7.6，95%CI：1.3-44.5，p=0.027）。没有儿童在接受挥发性麻醉剂后出现恶性高热或肝衰竭。
对于因哮喘而接受插管的儿童，在有和无挥发性麻醉剂暴露的儿童之间，机械通气时间和死亡率没有差异。虽然挥发性麻醉剂可能是严重哮喘的一种可行的抢救治疗方法，但仍需要明确的、前瞻性的试验。
