低氧性细支气管炎婴儿入住重症监护病房的预测因素：一项随机试验的二次分析。

Predictors of Intensive Care Admission in Hypoxemic Bronchiolitis Infants, Secondary Analysis of a Randomized Trial.

机构信息

Gold Coast University Hospital, Children's Emergency and Critical Care Collaborative Research Group, Southport, Australia; Gold Coast University Hospital, Children's Critical Care, Southport, Australia; Menzies Health Institute Queensland, Griffith University, Australia; The University of Queensland, Faculty of Medicine, Brisbane, Australia; Paediatric Research in Emergency Departments International Collaborative (PREDICT), Melbourne, Victoria, Australia.

Paediatric Research in Emergency Departments International Collaborative (PREDICT), Melbourne, Victoria, Australia; Emergency Department, Royal Children's Hospital, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia.

出版信息

J Pediatr. 2023 May;256:92-97.e1. doi: 10.1016/j.jpeds.2022.12.006. Epub 2022 Dec 14.

DOI:10.1016/j.jpeds.2022.12.006

PMID:36528052

Abstract

OBJECTIVES

To evaluate in a preplanned secondary analysis of our parent randomized controlled trial predictors of intensive care unit (ICU) admission in infants with bronchiolitis and analyze if these predictors are equally robust for children receiving high-flow or standard-oxygen.

STUDY DESIGN

A secondary analysis of a multicenter, randomized trial of infants aged <12 months with bronchiolitis and an oxygen requirement was performed using admission and outcome data of all 1472 enrolled infants. The primary outcome was ICU admission. The predictors evaluated were baseline characteristics including physiological data and medical history.

RESULTS

Of the 1472 enrolled infants, 146 were admitted to intensive care. Multivariate predictors of ICU admission were age (weeks) (OR: 0.98 [95% CI: 0.96-0.99]), pre-enrolment heart rate >160/min (OR: 1.80 [95% CI: 1.23-2.63]), pre-enrolment SpO (transcutaneous oxygen saturation) (%) (OR: 0.91 [95% CI: 0.86-0.95]), previous ICU admission (OR: 2.16 [95% CI: 1.07-4.40]), and time of onset of illness to hospital presentation (OR: 0.78 [95% CI: 0.65-0.94]). The predictors were equally robust for infants on high-flow nasal cannula therapy or standard-oxygen therapy.

CONCLUSION

Age <2 months, pre-enrolment heart rate >160/min, pre-enrolment SpO of <87%, previous ICU admission and time of onset of ≤2 days to presentation are predictive of an ICU admission during the current hospital admission of infants with bronchiolitis independent of oxygenation method used.

TRIAL REGISTRATION

ACTRN12613000388718.

摘要

目的

在我们的父母随机对照试验的预先计划的二次分析中评估毛细支气管炎婴儿入住重症监护病房（ICU）的预测因素，并分析这些预测因素是否对接受高流量或标准氧疗的儿童同样可靠。

研究设计

对 1472 名患有毛细支气管炎且需要吸氧的<12 个月龄婴儿进行多中心随机试验的二次分析，使用所有 1472 名入组婴儿的入院和结局数据。主要结局为 ICU 入院。评估的预测因素包括基线特征，包括生理数据和病史。

结果

在 1472 名入组婴儿中，有 146 名被收入 ICU。ICU 入院的多变量预测因素为年龄（周）（OR：0.98 [95%CI：0.96-0.99]）、入组前心率>160/min（OR：1.80 [95%CI：1.23-2.63]）、入组前 SpO（经皮血氧饱和度）（%）（OR：0.91 [95%CI：0.86-0.95]）、以前 ICU 入院（OR：2.16 [95%CI：1.07-4.40]）和发病至入院时间（OR：0.78 [95%CI：0.65-0.94]）。这些预测因素对接受高流量鼻导管治疗或标准氧疗的婴儿同样可靠。