Unki Praveen, Save Sushma
Department of Pediatrics, Adichunchanagiri Institute of Medical Sciences, Mandya 571448, India.
Department of Pediatrics, T.N.M.C and B.Y.L. Nair Charitable Hospital, Mumbai 400008, India.
Int J Pediatr. 2022 Mar 20;2022:2090323. doi: 10.1155/2022/2090323. eCollection 2022.
Ventilator-associated lung injury (VALI) is a devastating complication of assisted mechanical ventilation (AMV) and is one of the root causes of prolonged AMV. Many strategies were made to decrease the effect of the same. This study is conducted to determine the association of prolonged AMV with fluid balance and pediatric index of mortality 2 (PIM2) score.
This prospective observational study was carried out in a PICU of a tertiary care centre over a period of 12 months. Patient's fluid balance was calculated by tabulating fluid input-output over initial 48 hours of AMV. The PIM2 score on admission was documented. The association between qualitative variables was assessed by a chi-square test. Comparison of quantitative data measured between cases with duration of AMV ≥ 7 days and <7 days was done using the Mann-Whitney test. Correlation between quantitative data was done by using the Pearson product moment correlation.
Out of 40 patients, 27 patients who had ≥15% positive fluid balance required prolonged mechanical ventilation. Similarly, 27 patients with PIM2 score ≥ 5 required prolonged AMV. On applying the Pearson chi-square test, we found a significant association between positive fluid balance and prolonged mechanical ventilation ( value = 2.25 × 10 (<0.05)). Likewise, a statistically significant association was found between PIM2 score and prolonged ventilation ( value = 1.19 × 10 (<0.05)).
There is a significant association of prolonged AMV with positive fluid balance (>15%) and PIM2 score (>5). By strict maintenance of fluid balance with appropriate intervention, the length of AMV and PICU stay can be decreased.
呼吸机相关性肺损伤（VALI）是辅助机械通气（AMV）的一种严重并发症，也是AMV时间延长的根本原因之一。人们采取了多种策略来减轻其影响。本研究旨在确定AMV时间延长与液体平衡及小儿死亡率指数2（PIM2）评分之间的关联。
本前瞻性观察性研究在一家三级医疗中心的儿科重症监护病房（PICU）进行，为期12个月。通过记录AMV最初48小时的液体出入量来计算患者的液体平衡。记录入院时的PIM2评分。定性变量之间的关联通过卡方检验进行评估。使用曼-惠特尼检验对AMV持续时间≥7天和＜7天的病例之间测量的定量数据进行比较。定量数据之间的相关性通过皮尔逊积矩相关性进行分析。
40例患者中，27例液体平衡为正且≥15%的患者需要延长机械通气时间。同样，27例PIM2评分≥5的患者需要延长AMV时间。应用皮尔逊卡方检验时，我们发现液体正平衡与延长机械通气时间之间存在显著关联（值 = 2.25×10（<0.05））。同样，在PIM2评分与延长通气时间之间发现了具有统计学意义的关联（值 = 1.19×10（<0.05））。
AMV时间延长与液体正平衡（>15%）和PIM2评分（>5）之间存在显著关联。通过适当干预严格维持液体平衡，可以缩短AMV时间和PICU住院时间。
