造血干细胞移植后危重症患儿的围插管期不良事件。
Peri-Intubation Adverse Events in the Critically Ill Child After Hematopoietic Cell Transplant.
机构信息
Division of Critical Care, Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
Division of General Anesthesiology, Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
出版信息
Pediatr Crit Care Med. 2023 Jul 1;24(7):584-593. doi: 10.1097/PCC.0000000000003243. Epub 2023 Apr 26.
OBJECTIVES
Mechanically ventilated children post-hematopoietic cell transplant (HCT) have increased morbidity and mortality compared with other mechanically ventilated critically ill children. Tracheal intubation-associated adverse events (TIAEs) and peri-intubation hypoxemia universally portend worse outcomes. We investigated whether adverse peri-intubation associated events occur at increased frequency in patients with HCT compared with non-HCT oncologic or other PICU patients and therefore might contribute to increased mortality.
DESIGN
Retrospective cohort between 2014 and 2019.
SETTING
Single-center academic noncardiac PICU.
PATIENTS
Critically ill children who underwent tracheal intubation (TI).
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
Data from the local airway management quality improvement databases and Virtual Pediatric Systems were merged. These data were supplemented with a retrospective chart review for HCT-related data, including HCT indication, transplant-related comorbidity status, and patient condition at the time of TI procedure. The primary outcome was defined as the composite of hemodynamic TIAE (hypo/hypertension, arrhythmia, cardiac arrest) and/or peri-intubation hypoxemia (oxygen saturation < 80%) events. One thousand nine hundred thirty-one encounters underwent TI, of which 92 (4.8%) were post-HCT, while 319 (16.5%) had history of malignancy without HCT, and 1,520 (78.7%) had neither HCT nor malignancy. Children post-HCT were older more often had respiratory failure as an indication for intubation, use of catecholamine infusions peri-intubation, and use of noninvasive ventilation prior to intubation. Hemodynamic TIAE or peri-intubation hypoxemia were not different across three groups (HCT 16%, non-HCT with malignancy 10%, other 15). After adjusting for age, difficult airway feature, provider type, device, apneic oxygenation use, and indication for intubation, we did not identify an association between HCT status and the adverse TI outcome (odds ratio, 1.32 for HCT status vs other; 95% CI, 0.72-2.41; p = 0.37).
CONCLUSIONS
In this single-center study, we did not identify an association between HCT status and hemodynamic TIAE or peri-intubation hypoxemia during TI.
目的
与其他接受机械通气的危重症儿童相比，造血细胞移植（HCT）后接受机械通气的儿童发病率和死亡率更高。气管插管相关不良事件（TIAE）和插管期间低氧血症普遍预示着更差的结局。我们研究了与 HCT 相比，非 HCT 肿瘤或其他 PICU 患者中是否更频繁地发生与插管相关的不良事件，以及这些事件是否可能导致死亡率增加。
设计
2014 年至 2019 年的回顾性队列研究。
地点
单中心学术非心脏 PICU。
患者
接受气管插管（TI）的危重症儿童。
干预措施
无。
测量和主要结果
将当地气道管理质量改进数据库和 Virtual Pediatric Systems 的数据合并。这些数据通过回顾性图表补充了与 HCT 相关的数据，包括 HCT 指征、移植相关合并症状态以及 TI 时患者的病情。主要结局定义为血流动力学 TIAE（低血压/高血压、心律失常、心跳骤停）和/或插管期间低氧血症（氧饱和度<80%）事件的综合表现。1931 次插管中，92 次（4.8%）为 HCT 后，319 次（16.5%）有 HCT 相关恶性肿瘤史，1520 次（78.7%）既无 HCT 也无恶性肿瘤。HCT 后患儿年龄较大，更常因呼吸衰竭而需要插管，插管期间使用儿茶酚胺输注，且在插管前使用无创通气。三组之间血流动力学 TIAE 或插管期间低氧血症无差异（HCT 组 16%，非 HCT 伴恶性肿瘤组 10%，其他组 15%）。在校正年龄、气道困难特征、提供者类型、设备、无通气氧合使用和插管指征后，我们未发现 HCT 状态与不良 TI 结局之间存在关联（优势比，HCT 状态与其他状态相比为 1.32；95%CI，0.72-2.41；p=0.37）。
结论
在这项单中心研究中，我们未发现 HCT 状态与 TI 期间血流动力学 TIAE 或插管期间低氧血症之间存在关联。
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