儿科急性呼吸窘迫综合征的无创通气：2016/2017 年儿科急性呼吸窘迫综合征发病率和流行病学前瞻性队列研究的经验。
Noninvasive Ventilation for Pediatric Acute Respiratory Distress Syndrome: Experience From the 2016/2017 Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology Prospective Cohort Study.
机构信息
Department of Pediatrics, Pediatric Intensive Care Unit, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada.
Inmune and Respiratory Dysfunction in the Child Research Group, Institut de Recerca Sant Joan de Déu, Santa Rosa, Esplugues de Llobregat, Spain.
出版信息
Pediatr Crit Care Med. 2023 Sep 1;24(9):715-726. doi: 10.1097/PCC.0000000000003281. Epub 2023 May 31.
OBJECTIVES
The worldwide practice and impact of noninvasive ventilation (NIV) in pediatric acute respiratory distress syndrome (PARDS) is unknown. We sought to describe NIV use and associated clinical outcomes in PARDS.
DESIGN
Planned ancillary study to the 2016/2017 prospective Pediatric Acute Respiratory Distress Syndrome Incidence and Epidemiology study.
SETTING
One hundred five international PICUs.
PATIENTS
Patients with newly diagnosed PARDS admitted during 10 study weeks.
INTERVENTIONS
None.
MEASUREMENTS AND MAIN RESULTS
Children were categorized by their respiratory support at PARDS diagnosis into NIV or invasive mechanical ventilation (IMV) groups. Of 708 subjects with PARDS, 160 patients (23%) received NIV at PARDS diagnosis (NIV group). NIV failure rate (defined as tracheal intubation or death) was 84 of 160 patients (53%). Higher nonrespiratory pediatric logistic organ dysfunction (PELOD-2) score, Pa o2 /F io2 was less than 100 at PARDS diagnosis, immunosuppression, and male sex were independently associated with NIV failure. NIV failure was 100% among patients with nonrespiratory PELOD-2 score greater than 2, Pa o2 /F io2 less than 100, and immunosuppression all present. Among patients with Pa o2 /F io2 greater than 100, children in the NIV group had shorter total duration of NIV and IMV, than the IMV at initial diagnosis group. We failed to identify associations between NIV use and PICU survival in a multivariable Cox regression analysis (hazard ratio 1.04 [95% CI, 0.61-1.80]) or mortality in a propensity score matched analysis ( p = 0.369).
CONCLUSIONS
Use of NIV at PARDS diagnosis was associated with shorter exposure to IMV in children with mild to moderate hypoxemia. Even though risk of NIV failure was high in some children, we failed to identify greater hazard of mortality in these patients.
目的
目前全球范围内对儿科急性呼吸窘迫综合征（PARDS）患者进行无创通气（NIV）治疗的实践和影响尚不清楚。本研究旨在描述 PARDS 患者中 NIV 的应用情况及其与临床结局的相关性。
设计
2016/2017 年前瞻性儿科急性呼吸窘迫综合征发病和流行病学研究的辅助研究。
地点
105 家国际儿科重症监护病房（PICU）。
患者
10 个研究周内新诊断为 PARDS 并入住 PICU 的患儿。
干预措施
无。
测量指标和主要结果
根据 PARDS 诊断时的呼吸支持方式，患儿被分为 NIV 或有创机械通气（IMV）组。708 例 PARDS 患儿中，160 例（23%）患儿在 PARDS 诊断时接受了 NIV（NIV 组）。NIV 失败率（定义为气管插管或死亡）为 160 例患儿中的 84 例（53%）。更高的非呼吸系统儿科 LOGO 器官功能障碍评分（PELOD-2）、PARDS 诊断时 Pa o2 /F io2 小于 100、免疫抑制和男性是 NIV 失败的独立危险因素。PELOD-2 评分大于 2 分、PARDS 诊断时 Pa o2 /F io2 小于 100 分且存在免疫抑制的患儿中，NIV 失败率为 100%。在 Pa o2 /F io2 大于 100 分的患儿中，与初始诊断时即接受 IMV 的患儿相比，NIV 组患儿接受 NIV 和 IMV 的总时间更短。多变量 Cox 回归分析未能确定 NIV 使用与 PICU 生存率（危险比 1.04[95%CI，0.61-1.80]）之间的相关性，也未能在倾向评分匹配分析中确定 NIV 使用与死亡率（p=0.369）之间的相关性。
结论
在 Pa o2 /F io2 为轻度至中度低氧血症的患儿中，PARDS 诊断时使用 NIV 与接受 IMV 的时间更短相关。尽管一些患儿 NIV 失败的风险较高，但本研究未能确定这些患儿的死亡率风险更高。
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