无创通气或持续气道正压通气用于小婴儿拔管后支持
Noninvasive Ventilation or CPAP for Postextubation Support in Small Infants.
作者信息
Miller Andrew G, Kumar Karan R, Adagarla Bhargav S, Haynes Kaitlyn E, Watts Rachel M, Muddiman Jeanette L, Heath Travis S, Allareddy Veerajalandhar, Rotta Alexandre T
机构信息
Division of Pediatric Critical Care Medicine, Duke University Medical Center, Durham, North Carolina; and Respiratory Care Services, Duke University Medical Center, Durham, North Carolina.
Division of Pediatric Critical Care Medicine, Duke University Medical Center, Durham, North Carolina; and Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
出版信息
Respir Care. 2023 Dec 28;69(1):82-90. doi: 10.4187/respcare.11194.
BACKGROUND
Infants with a high risk of extubation failure are often treated with noninvasive ventilation (NIV) or CPAP, but data on the role of these support modalities following extubation are sparse. This report describes our experience using NIV or CPAP to support infants following extubation in our pediatric ICUs (PICUs).
METHODS
We performed a retrospective study of children < 10 kg receiving postextubation NIV or CPAP in our PICUs. Data on demographics, medical history, type of support, vital signs, pulse oximetry, near-infrared spectroscopy (NIRS), gas exchange, support settings, and re-intubation were extracted from the electronic medical record. Support was classified as prophylactic if planned before extubation and rescue if initiated within 24 h of extubation. We compared successfully extubated and re-intubated subjects using chi-square test for categorical variables and Mann-Whitney test for continuous variables.
RESULTS
We studied 51 subjects, median age 44 (interquartile range 0.5-242) d and weight 3.7 (3-4.9) kg. There were no demographic differences between groups, except those re-intubated were more likely to have had cardiac surgery prior to admission (0% vs 14%, = .040). NIV was used in 31 (61%) and CPAP in 20 (39%) subjects. Prophylactic support was initiated in 25 subjects (49%), whereas rescue support was needed in 26 subjects (51%). Twenty-two subjects (43%) required re-intubation. Re-intubation rate was higher for rescue support (58% vs 28%, = .032). Subjects with a pH < 7.35 (4.3% vs 42.0%, = .003) and lower somatic NIRS (39 [24-56] vs 62 [46-72], = .02) were more likely to be re-intubated. The inspiratory positive airway pressure, expiratory positive airway pressure, and F were higher in subjects who required re-intubation.
CONCLUSIONS
NIV or CPAP use was associated with a re-intubation rate of 43% in a heterogeneous sample of high-risk infants. Acidosis, cardiac surgery, higher F , lower somatic NIRS, higher support settings, and application of rescue support were associated with the need for re-intubation.
背景
拔管失败风险高的婴儿常接受无创通气（NIV）或持续气道正压通气（CPAP）治疗，但关于这些支持方式在拔管后的作用的数据很少。本报告描述了我们在儿科重症监护病房（PICU）中使用NIV或CPAP支持婴儿拔管后的经验。
方法
我们对在我们的PICU中接受拔管后NIV或CPAP治疗的体重<10 kg的儿童进行了一项回顾性研究。从电子病历中提取了人口统计学、病史、支持类型、生命体征、脉搏血氧饱和度、近红外光谱（NIRS）、气体交换、支持设置和再次插管的数据。如果在拔管前计划使用，则支持被分类为预防性的；如果在拔管后24小时内开始使用，则为抢救性的。我们使用卡方检验对分类变量和曼-惠特尼检验对连续变量比较成功拔管和再次插管的受试者。
结果
我们研究了51名受试者，中位年龄44（四分位间距0.5 - 242）天，体重3.7（3 - 4.9）kg。两组之间在人口统计学上没有差异，除了再次插管的受试者在入院前更有可能接受过心脏手术（0%对14%，P = 0.040）。31名（61%）受试者使用了NIV，20名（39%）受试者使用了CPAP。25名受试者（49%）开始了预防性支持，而26名受试者（51%）需要抢救性支持。22名受试者（43%）需要再次插管。抢救性支持的再次插管率更高（58%对28%，P = 0.032）。pH<7.35的受试者（4.3%对42.0%，P = 0.003）和较低的躯体NIRS（39[24 - 56]对62[46 - 72]，P = 0.02）更有可能再次插管。需要再次插管的受试者的吸气气道正压、呼气气道正压和F更高。
结论
在高危婴儿的异质性样本中，使用NIV或CPAP与43%的再次插管率相关。酸中毒、心脏手术、较高的F、较低的躯体NIRS、较高的支持设置以及抢救性支持的应用与再次插管的需求相关。
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