Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatric Intensive Care, Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands.
Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatrics, Follow-Me Program & Emma Neuroscience Group, Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands.
Pediatr Crit Care Med. 2022 Oct 1;23(10):801-811. doi: 10.1097/PCC.0000000000003022. Epub 2022 Jul 29.
Bronchiolitis is a common indication for mechanical ventilation in the PICU. Both bronchiolitis and invasive mechanical ventilation may cause adverse long-term pulmonary outcomes. This study investigates children with a history of invasive mechanical ventilation for bronchiolitis, addressing: 1) the extent, 2) potential explanatory factors, and 3) possible impact on daily life activities of adverse long-term pulmonary outcomes.
Single-center cohort study.
Outpatient PICU follow-up clinic.
Children 6-12 years old with a history of invasive mechanical ventilation for bronchiolitis (age < 2 yr).
None.
Long-term pulmonary outcomes were assessed by a standardized questionnaire and by spirometry. Nineteen out of 74 included children (26%) had adverse long-term pulmonary outcomes, of whom the majority had asthma (14/74, 19%). By logistic regression analysis, we assessed whether background characteristics and PICU-related variables were associated with long-term pulmonary outcomes. In general, we failed to identify any explanatory factors associated with adverse long-term pulmonary outcomes. Nonetheless, atopic disease in family and longer duration of invasive mechanical ventilation (days) were associated with greater odds of having asthma at follow-up (odds ratio, 6.4 [95% CI, 1.2-36.0] and 1.3 [95% CI, 1.0-1.7], respectively). Adverse pulmonary outcome at follow-up was associated with more frequent use of pulmonary medication after PICU discharge. In comparison with those without adverse pulmonary outcomes, we did not identify any difference in frequency of sports performance or school absenteeism.
In this single-center cohort, one-quarter of the children attending follow-up with a history of invasive mechanical ventilation for bronchiolitis had adverse, mostly previously undetected, long-term pulmonary outcomes at 6-12 years. Atopic disease in family and longer duration of invasive mechanical ventilation were associated with presence of asthma. The presence of adverse pulmonary outcomes was associated with more frequent use of pulmonary medication after PICU discharge.
毛细支气管炎是小儿重症监护病房（PICU）机械通气的常见指征。毛细支气管炎和有创机械通气均可导致不良的长期肺部结局。本研究调查了因毛细支气管炎行有创机械通气的儿童，以明确：1）长期肺部结局的发生程度，2）可能的解释因素，以及 3）其对日常生活活动的潜在影响。
单中心队列研究。
门诊 PICU 随访诊所。
因毛细支气管炎行有创机械通气的 6-12 岁儿童（年龄＜2 岁）。
无。
采用标准化问卷和肺量计评估长期肺部结局。74 例纳入患儿中有 19 例（26%）存在不良的长期肺部结局，其中大多数患儿患有哮喘（74 例中有 14 例，19%）。通过逻辑回归分析，我们评估了背景特征和 PICU 相关变量是否与长期肺部结局相关。总体而言，我们未发现任何与不良长期肺部结局相关的解释因素。尽管如此，家族性特应性疾病和有创机械通气时间（天）较长与随访时哮喘的可能性更大相关（比值比分别为 6.4 [95%可信区间，1.2-36.0]和 1.3 [95%可信区间，1.0-1.7]）。随访时出现不良肺部结局与 PICU 出院后更频繁使用肺部药物治疗相关。与无不良肺部结局的患儿相比，我们未发现两组在运动表现或缺课频率方面存在差异。
在本单中心队列中，在因毛细支气管炎行有创机械通气的儿童中，1/4 在 6-12 岁时出现不良的、大多是先前未被发现的长期肺部结局。家族性特应性疾病和有创机械通气时间较长与哮喘的存在相关。不良肺部结局的存在与 PICU 出院后更频繁使用肺部药物治疗相关。
