急性呼吸窘迫儿科高依赖病房无创呼吸支持的结果。
Outcome of Noninvasive Respiratory Support in Pediatric High-Dependency Units for Acute Respiratory Distress.
机构信息
Pediatric Intensive Care Section, Department of Child Health, Royal Hospital, Muscat, Oman.
Pediatrics Section, Sohar Hospital, Sohar, Oman.
出版信息
Respir Care. 2023 Sep;68(9):1237-1244. doi: 10.4187/respcare.10603. Epub 2023 Mar 27.
BACKGROUND
Noninvasive respiratory support (NRS) is widely used in pediatric ICUs (PICUs). However, there is limited experience regarding the utilization of NRS in non-PICU settings. We aimed to evaluate the success rate of NRS in pediatric high-dependency units (PHDUs), identify predictors of NRS failure, quantify adverse events, and assess outcomes.
METHODS
We included infants and children (> 7 d to < 13 y old) admitted to PHDU in 2 tertiary hospitals for acute respiratory distress over a 19-month period. Collected data included diagnosis, type and duration of NRS, adverse events, and the need for PICU transfer or invasive ventilation.
RESULTS
Two hundred and ninety-nine children were included, with a median age of 7 (interquartile range [IQR] 3-25) months and a median weight of 6.1 (IQR 4.3-10.5) kg. Bronchiolitis (37.5%), pneumonia (34.1%), and asthma (12.7%) were the most frequent diagnoses. Median NRS duration was 2 (IQR 1-3) d. At baseline, median S was 96% (IQR 90-99); median pH was 7.36 (IQR 7.31-7.41), and median P was 44 (IQR 36-53) mm Hg. Overall, 234 (78.3%) children were successfully managed in PHDU, whereas 65 (21.7%) required transfer to PICU. Thirty-eight (12.7%) needed invasive ventilation on a median time of 43.5 (IQR 13.5-108.0) h. On multivariable analysis, maximum F > 0.5 (odds ratio 4.49 [95% CI 1.36-14.9], = .01) and PEEP > 7 cm HO (odds ratio 3.37 [95% CI 1.49-7.61], = .004) were predictors for NRS failure. Significant apnea, cardiopulmonary resuscitation, and air leak syndrome were reported in 0.3, 0.7, and 0.7% children, respectively.
CONCLUSIONS
In our cohort, we found NRS in PHDU safe and effective; however, maximum F > 0.5 post treatment and PEEP > 7 cm HO were associated with NRS failure.
背景
非侵入性呼吸支持（NRS）在儿科 ICU（PICU）中广泛应用。然而，关于 NRS 在非 PICU 环境中的应用经验有限。我们旨在评估 NRS 在儿科高依赖病房（PHDU）中的成功率，确定 NRS 失败的预测因素，量化不良事件，并评估结局。
方法
我们纳入了在 2 家三级医院 PHDU 中因急性呼吸窘迫而入院的婴儿和儿童（>7 天至<13 岁），时间为 19 个月。收集的数据包括诊断、NRS 的类型和持续时间、不良事件以及需要 PICU 转科或有创通气的情况。
结果
共纳入 299 例患儿，中位年龄为 7（四分位间距 [IQR] 3-25）个月，中位体重为 6.1（IQR 4.3-10.5）kg。毛细支气管炎（37.5%）、肺炎（34.1%）和哮喘（12.7%）是最常见的诊断。NRS 中位持续时间为 2（IQR 1-3）d。基线时，中位 S 为 96%（IQR 90-99）；中位 pH 值为 7.36（IQR 7.31-7.41），中位 P 为 44（IQR 36-53）mmHg。总体而言，234（78.3%）例患儿在 PHDU 中成功治疗，65（21.7%）例患儿需要转科至 PICU。38（12.7%）例患儿需要有创通气，中位时间为 43.5（IQR 13.5-108.0）h。多变量分析显示，最大 F > 0.5（比值比 4.49[95%CI 1.36-14.9]，.01）和 PEEP > 7 cm HO（比值比 3.37[95%CI 1.49-7.61]，.004）是 NRS 失败的预测因素。分别有 0.3%、0.7%和 0.7%的患儿出现显著呼吸暂停、心肺复苏和气胸综合征。
结论
在我们的队列中，我们发现 PHDU 中的 NRS 安全且有效；然而，治疗后最大 F > 0.5 和 PEEP > 7 cm HO 与 NRS 失败相关。
Zotero 插件