Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Department of Pediatrics, University of Cincinnati, Cincinnati, Ohio, USA.
Pediatr Pulmonol. 2022 Feb;57(2):560-566. doi: 10.1002/ppul.25771. Epub 2021 Dec 2.
With advances in technology, pediatric patients are sent home with chronic invasive mechanical ventilation (CIMV). Ventilation optimization and preparation for weaning are essential processes, however, there is no standard approach to weaning and titrating ventilator settings in children. There is little information in the literature on the utility of polysomnography (PSG) in weaning and titration of CIMV. Our objective is to review the role of PSG on titration and weaning of CIMV in children.
A retrospective review of medical records and polysomnograms was performed on CIMV dependent patients at Cincinnati Children's Hospital Medical Center from January 2011 to October 2017. Patients underwent overnight ventilator weaning or titration PSG. Subjects with less than 3 h of total sleep time were excluded.
About 163 PSGs were divided into 97 PSGs for ventilator titration and 66 PSGs for ventilator weaning. Of the 97 ventilator titration PSGs, 59 (60.8%) had inadequate ventilation, 10 (10.3%) had inadequate oxygenation, 22 (22.7%) had significant tracheostomy leak, 13 (13.4%) had autocycling, 3 (3.1%) had failure to trigger, 4 (4.1%) had central sleep apnea, and 24 (25.8%) had adequate ventilation on current ventilator settings. Of the 66 ventilator weaning PSGs, 48 (72.7%) weaned to lower ventilator settings or off ventilator support and 18 (27.3%) did not wean.
Our results indicate that PSG is useful in titration and weaning of ventilator settings in children with CIMV. Larger studies are needed to evaluate the subgroup of this population who would benefit most from PSG for assessment of adequate ventilator support.
随着技术的进步，患有慢性侵入性机械通气（CIMV）的儿科患者被送回家中。通气优化和脱机准备是至关重要的过程，然而，目前尚无儿童脱机和呼吸机参数滴定的标准方法。关于在 CIMV 脱机和滴定中使用多导睡眠图（PSG）的文献资料很少。我们的目的是回顾 PSG 在儿童 CIMV 滴定和脱机中的作用。
对 2011 年 1 月至 2017 年 10 月期间辛辛那提儿童医院医疗中心接受 CIMV 治疗的患者进行了回顾性病历和 PSG 回顾。患者接受了夜间呼吸机脱机或滴定 PSG。总睡眠时间少于 3 小时的患者被排除在外。
大约 163 次 PSG 被分为 97 次用于呼吸机滴定和 66 次用于呼吸机脱机。在 97 次呼吸机滴定 PSG 中，59 次（60.8%）通气不足，10 次（10.3%）氧合不足，22 次（22.7%）存在明显的气管造口漏，13 次（13.4%）存在自动循环，3 次（3.1%）存在无法触发，4 次（4.1%）存在中枢性睡眠呼吸暂停，24 次（25.8%）在当前呼吸机设置下通气充足。在 66 次呼吸机脱机 PSG 中，48 次（72.7%）脱机至较低的呼吸机设置或脱机支持，18 次（27.3%）未脱机。
我们的结果表明，PSG 可用于 CIMV 儿童的呼吸机参数滴定和脱机。需要更大的研究来评估从 PSG 评估充足的呼吸机支持中获益最大的这部分人群亚组。
