Schreiner M S, Downes J J, Kettrick R G, Ise C, Voit R
Department of Anesthesia and Critical Care, Children's Hospital of Philadelphia, PA 19104.
JAMA. 1987 Dec 18;258(23):3398-404.
One hundred one infants with chronic respiratory failure (CRF) who required prolonged mechanical ventilation were cared for in the pediatric intensive care unit at The Children's Hospital of Philadelphia between January 1967 and December 1984. Chronic respiratory failure of infancy is a condition that requires mechanical ventilation for more than 28 days in the first year of life. Thirty-six children had severe bronchopulmonary dysplasia, 50 had congenital anomalies, and 15 had neuromuscular disorders. The mean duration of mechanical ventilation for the 101 patients was 12.3 months. Seventy-one children were alive, and 53 (75%) of the 71 had been weaned from mechanical ventilation as of Dec 31, 1984. Pulmonary insufficiency and cardiac failure were the predominant causes of death in 17 of 22 infants in the first two years after the onset of CRF; four of eight deaths that occurred beyond two years were caused by airway- and ventilator-related accidents. Mechanical ventilatory support was emphasized for as long as necessary to provide normal blood gas tensions, nutrition, growth, and development rather than weaning as rapidly as possible. This clinical experience demonstrates that it is feasible to save over 70% of infants with the severest forms of CRF and prolonged ventilator dependency.
1967年1月至1984年12月期间，费城儿童医院的儿科重症监护病房对101例需要长期机械通气的慢性呼吸衰竭（CRF）婴儿进行了护理。婴儿慢性呼吸衰竭是一种在生命的第一年需要机械通气超过28天的病症。36名儿童患有严重的支气管肺发育不良，50名患有先天性异常，15名患有神经肌肉疾病。101例患者的机械通气平均持续时间为12.3个月。截至1984年12月31日，71名儿童存活，其中53名（75%）已脱离机械通气。在CRF发病后的头两年，22例婴儿中有17例的主要死亡原因是肺功能不全和心力衰竭；两年后发生的8例死亡中有4例是由气道和呼吸机相关事故引起的。强调只要有必要就进行机械通气支持，以维持正常的血气张力、营养、生长和发育，而不是尽快撤机。这一临床经验表明，挽救超过70%患有最严重形式的CRF和长期呼吸机依赖的婴儿是可行的。
