高频鼻导管在毛细支气管炎、哮喘和肺炎中的应用频率及相关因素。
Frequency and Correlates of Pediatric High-Flow Nasal Cannula Use for Bronchiolitis, Asthma, and Pneumonia.
机构信息
Indiana University School of Medicine, Indianapolis, Indiana; and Regenstrief Institute Center for Biomedical Informatics, Indianapolis, Indiana.
Indiana University School of Medicine, Indianapolis, Indiana.
出版信息
Respir Care. 2022 Aug;67(8):976-984. doi: 10.4187/respcare.09777. Epub 2022 May 24.
BACKGROUND
Heated humidified high-flow nasal cannula (HFNC) is a respiratory support device historically used in pediatrics for infants with bronchiolitis. No large-scale analysis has determined the current frequency or demographic distribution of HFNC use in children. The objective of this study was to determine the frequency and correlates of HFNC use in children presenting to the hospital for asthma, bronchiolitis, or pneumonia.
METHODS
This longitudinal observational study was based on electronic health record data from a large regional health information exchange, the Indiana Network for Patient Care (INPC). Subjects were age 0-18 y with recorded hospital encounters at an INPC hospital between 2010-2019 with International Classification of Diseases codes for bronchiolitis, asthma, or pneumonia. Annual proportions of HFNC use among all hospital encounters were assessed using generalized additive models. Log-binomial regression models were used to identify correlates of incident HFNC use and determine risk ratios of specific subjects receiving HFNC.
RESULTS
The study sample included 242,381 unique subjects with 412,712 hospital encounters between 2010-2019. The 10-y period prevalence of HFNC use was 2.54% (6,155/242,381) involving 7,974 encounters. Hospital encounters utilizing HFNC increased by 400%, from 326 in 2010 to 1,310 in 2019. This increase was evenly distributed across all 3 diagnostic categories (bronchiolitis, asthma, and pneumonia). Sex, race, age, and ethnicity all significantly influenced the risk of HFNC use. Over the 10-y period, the percentage of all hospital encounters using HFNC increased from 1.11% in 2010 to 3.15% in 2018. Subjects with multiple diagnoses had significantly higher risk of receiving HFNC.
CONCLUSIONS
The use of HFNC in children presenting to the hospital with common respiratory diseases has increased substantially over the past decade and is no longer confined to treating infants with bronchiolitis. Demographic and diagnostic factors significantly influenced the frequency of HFNC use.
背景
加热湿化高流量鼻导管（HFNC）是一种呼吸支持设备，历史上用于治疗毛细支气管炎的婴儿。目前还没有大规模的分析来确定 HFNC 在儿童中的使用频率或人口分布。本研究的目的是确定在因哮喘、毛细支气管炎或肺炎而到医院就诊的儿童中 HFNC 的使用频率及其相关因素。
方法
本纵向观察性研究基于大型区域健康信息交换机构印第安纳州患者护理网络（INPC）的电子健康记录数据。研究对象为年龄在 0-18 岁之间，在 INPC 医院记录有 2010-2019 年毛细支气管炎、哮喘或肺炎国际疾病分类代码的住院患者。使用广义加性模型评估 HFNC 在所有住院患者中的年度使用率。使用对数二项式回归模型来确定 HFNC 使用的相关因素，并确定特定患者接受 HFNC 的风险比。
结果
研究样本包括 242381 名独特的患者，2010-2019 年期间有 412712 次住院经历。HFNC 使用的 10 年期间患病率为 2.54%（6155/242381），涉及 7974 次住院经历。使用 HFNC 的住院经历增加了 400%，从 2010 年的 326 次增加到 2019 年的 1310 次。这种增加在所有 3 个诊断类别（毛细支气管炎、哮喘和肺炎）中分布均匀。性别、种族、年龄和种族都显著影响 HFNC 使用的风险。在 10 年期间，使用 HFNC 的所有住院经历的百分比从 2010 年的 1.11%增加到 2018 年的 3.15%。有多种诊断的患者接受 HFNC 的风险显著增加。
结论
在过去十年中，HFNC 在因常见呼吸道疾病到医院就诊的儿童中的使用显著增加，并且不再局限于治疗毛细支气管炎的婴儿。人口统计学和诊断因素显著影响 HFNC 的使用频率。
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