新冠疫情初期儿童急性低氧血症呼吸衰竭：一项全国性经验
Acute Hypoxemic Respiratory Failure in Children at the Start of COVID-19 Outbreak: A Nationwide Experience.
作者信息
López-Fernández Yolanda M, Martínez-de-Azagra Amelia, González-Gómez José M, Pérez-Caballero Macarrón César, García-González María, Parrilla-Parrilla Julio, Miñambres-Rodríguez María, Madurga-Revilla Paula, Gómez-Zamora Ana, Rodríguez-Campoy Patricia, Mayordomo-Colunga Juan, Butragueño-Laiseca Laura, Núñez-Borrero Rocío, González-Martín Jesús M, Slutsky Arthur S, Villar Jesús
机构信息
Pediatric Intensive Care Unit, Hospital Universitario de Cruces, Biocruces-Bizkaia Health Research Institute, 48903 Barakaldo, Spain.
Pediatric Intensive Care Unit, Hospital Universitario Niño Jesús, 28009 Madrid, Spain.
出版信息
J Clin Med. 2021 Sep 22;10(19):4301. doi: 10.3390/jcm10194301.
STUDY DESIGN
This is a prospective, multicenter, and observational study with the aim of describing physiological characteristics, respiratory management, and outcomes of children with acute hypoxemic respiratory failure (AHRF) from different etiologies receiving invasive mechanical ventilation (IMV) compared with those affected by SARS-CoV-2.
METHODS AND MAIN RESULTS
Twenty-eight patients met the inclusion criteria: 9 patients with coronavirus disease 2019 (COVID-19) and 19 patients without COVID-19. Non-COVID-19 patients had more pre-existing comorbidities (78.9% vs. 44.4%) than COVID-19 patients. At AHRF onset, non-COVID-19 patients had worse oxygenation (PaO/FiO = 95 mmHg (65.5-133) vs. 150 mmHg (105-220), = 0.04), oxygenation index = 15.9 (11-28.4) vs. 9.3 (6.7-10.6), = 0.01), and higher PaCO (48 mmHg (46.5-63) vs. 41 mmHg (40-45), = 0.07, that remained higher at 48 h: 54 mmHg (43-58.7) vs. 41 (38.5-45.5), = 0.03). In 12 patients (5 COVID-19 and 7 non-COVID-19), AHRF evolved to pediatric acute respiratory distress syndrome (PARDS). All non-COVID-19 patients had severe PARDS, while 3 out of 5 patients in the COVID-19 group had mild or moderate PARDS. Overall Pediatric Intensive Care Medicine (PICU) mortality was 14.3%.
CONCLUSIONS
Children with AHRF due to SARS-CoV2 infection had fewer comorbidities and better oxygenation than patients with non-COVID-19 AHRF. In this study, progression to severe PARDS was rarely observed in children with COVID-19.
研究设计
这是一项前瞻性、多中心观察性研究，旨在描述不同病因的急性低氧性呼吸衰竭（AHRF）患儿接受有创机械通气（IMV）时的生理特征、呼吸管理及预后，并与感染新型冠状病毒2019（SARS-CoV-2）的患儿进行比较。
方法与主要结果
28例患者符合纳入标准，其中9例为新型冠状病毒病2019（COVID-19）患者，19例为非COVID-19患者。非COVID-19患者比COVID-19患者有更多的基础合并症（78.9%对44.4%）。在AHRF发病时，非COVID-19患者的氧合情况更差（动脉血氧分压/吸入氧分数值[PaO₂/FiO₂] = 95 mmHg[65.5 - 133]对150 mmHg[105 - 220]，P = 0.04；氧合指数 = 15.9[11 - 28.4]对9.3[6.7 - 10.6]，P = 0.01），且动脉血二氧化碳分压（PaCO₂）更高（48 mmHg[46.5 - 63]对41 mmHg[40 - 45]，P = 0.07，48小时时仍更高：54 mmHg[43 - 58.7]对41[38.5 - 45.5]，P = 0.03）。12例患者（5例COVID-19患者和7例非COVID-19患者）的AHRF进展为儿童急性呼吸窘迫综合征（PARDS）。所有非COVID-19患者均为重度PARDS，而COVID-19组5例患者中有3例为轻度或中度PARDS。儿科重症监护病房（PICU）总体死亡率为14.3%。
结论
与非COVID-19 AHRF患者相比，SARS-CoV-2感染所致AHRF患儿的合并症更少，氧合情况更好。在本研究中，COVID-19患儿很少进展为重度PARDS。
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