Department of Pediatrics, Division of Pediatric Critical Care and Sedation Services, Tripler Army Medical Center, Honolulu, Hawaii.
Department of Pediatrics, University of Michigan, C.S. Mott Children's Hospital, Ann Arbor, Michigan.
Respir Care. 2022 Aug;67(8):956-966. doi: 10.4187/respcare.09348. Epub 2022 Jun 14.
It remains unknown if pediatric patients failing initial noninvasive ventilation (NIV) experience worse clinical outcomes than those successfully treated with NIV or those primarily intubated.
This was a single-center, retrospective review of patients admitted with acute respiratory failure to the University of Michigan pediatric intensive care or cardiothoracic ICUs and receiving NIV or invasive mechanical ventilation as first-line therapy.
One hundred seventy subjects met inclusion criteria and were enrolled: 65 NIV success, 55 NIV failure, and 50 invasive mechanical ventilation alone. Of those failing NIV, median time to intubation was 1.8 (interquartile range [IQR] < 1-7) h. On multivariable regression, ICU-free days were significantly different between groups (NIV success: 22.9 ± 6.9 d; NIV failure: 13.0 6.6 d; invasive ventilation: 12.5 6.9 d; < .001 across all groups). Multivariable regression revealed no difference in ventilator-free days between NIV failure and invasive ventilation groups (15.4 10.1 d vs 15.9 9.7 d, = .71). Of 64 subjects (37.6%) meeting Pediatric Acute Lung Injury Consensus Conference pediatric ARDS criteria, only 14% were successfully treated with NIV. Ventilator-free days were similar between the NIV failure and invasive ventilation groups (11.6 vs 13.2 d, = .47). On multivariable analysis, ICU-free days were significantly different across pediatric ARDS groups ( < .001): NIV success: 20.8 + 31.7 d; NIV failure: 8.3 + 23.8 d; invasive alone: 8.9 + 23.9 d, yet no significant difference in ventilator-free days between those with NIV failure versus invasive alone (11.6 vs 13.2 d, = .47).
We demonstrated that critically ill pediatric subjects unsuccessfully trialed on NIV did not experience increased ICU length of stay or fewer ventilator-free days when compared to those on invasive mechanical ventilation alone, including in the pediatric ARDS subgroup. Our findings are predicated on a median time to intubation of < 2 h in the NIV failure group and the provision of adequate monitoring while on NIV.
目前尚不清楚初始无创通气（NIV）治疗失败的儿科患者与 NIV 治疗成功或主要行有创机械通气的患者相比，临床结局是否更差。
这是一项单中心、回顾性研究，纳入了在密歇根大学儿科重症监护病房或心胸重症监护病房因急性呼吸衰竭入院并接受 NIV 或有创机械通气作为一线治疗的患者。
170 名符合纳入标准的患者入选：65 名 NIV 成功，55 名 NIV 失败，50 名单独行有创机械通气。NIV 失败的患者中，气管插管中位时间为 1.8（四分位距[IQR]＜1-7）h。多变量回归分析显示，各组间 ICU 无天数存在显著差异（NIV 成功：22.9±6.9 d；NIV 失败：13.0±6.6 d；有创通气：12.5±6.9 d；P＜0.001）。多变量回归分析显示，NIV 失败与有创通气组间呼吸机无天数无差异（15.4±10.1 d 与 15.9±9.7 d，P=0.71）。64 名（37.6%）符合小儿急性肺损伤共识会议小儿急性呼吸窘迫综合征标准的患者中，仅有 14%成功接受 NIV 治疗。NIV 失败组和有创通气组间呼吸机无天数相似（11.6 与 13.2 d，P=0.47）。多变量分析显示，小儿急性呼吸窘迫综合征各组间 ICU 无天数存在显著差异（P＜0.001）：NIV 成功：20.8±31.7 d；NIV 失败：8.3±23.8 d；单独有创通气：8.9±23.9 d，但 NIV 失败与单独有创通气相比，呼吸机无天数无显著差异（11.6 与 13.2 d，P=0.47）。
我们发现，与单独行有创机械通气相比，NIV 治疗失败的危重症儿科患者并未增加 ICU 住院时间或呼吸机无天数，包括在小儿急性呼吸窘迫综合征亚组中。我们的研究结果基于 NIV 失败组中气管插管中位时间＜2 h 以及在 NIV 期间进行充分监测的前提下得出。
