Drs Wong and Lee are affiliated with Children's Intensive Care Unit, Department of Pediatric Subspecialties, KK Women's and Children's Hospital, Singapore; and Paediatric Academic Clinical Programme, Duke-NUS Medical School, Singapore. Mss Tan, Ma, and Goh and Messrs Aguilan and Lee are affiliated with Children's Intensive Care Unit, Department of Pediatric Subspecialties, KK Women's and Children's Hospital, Singapore. Ms Sultana is affiliated with Center for Quantitative Medicine, Duke-NUS Medical School, Singapore. Dr Kumar is affiliated with Translational Immunology Institute, SingHealth/Duke-NUS Academic Medical Centre, Singapore.
Respir Care. 2024 Mar 27;69(4):422-429. doi: 10.4187/respcare.11334.
Postextubation respiratory support in pediatric ARDS may be used to support the recovering respiratory system and promote timely, successful liberation from mechanical ventilation. This study's aims were to (1) describe the use of postextubation respiratory support in pediatric ARDS from the time of extubation to hospital discharge, (2) identify potential risk factors for postextubation respiratory support, and (3) provide preliminary data for future larger studies.
This pilot single-center prospective cohort study recruited subjects with pediatric ARDS. Subjects' respiratory status up to hospital discharge, the use of postextubation respiratory support, and how it changed over time were recorded. Analysis was performed comparing subjects who received postextubation respiratory support versus those who did not and compared its use among pediatric ARDS severity categories. Multivariable logistic regression was used to determine variables associated with the use of postextubation respiratory support and included oxygenation index (OI), ventilator duration, and weight.
Seventy-three subjects with pediatric ARDS, with median age and OI of 4 (0.6-10.5) y and 7.3 (4.9-12.7), respectively, were analyzed. Postextubation respiratory support was provided to 54/73 (74%) subjects: 28/45 (62.2%), 19/21 (90.5%), and 7/7 (100%) for mild, moderate, and severe pediatric ARDS, respectively, ( = .01). OI and mechanical ventilation duration were higher in subjects who received postextubation respiratory support (8.7 [5.4-14] vs 4.6 [3.7-7], < .001 and 10 [7-17] d vs 4 [2-7] d, < .001) compared to those who did not. At hospital discharge, 12/67 (18.2%) survivors received home respiratory support (6 subjects died prior to hospital discharge). In the multivariable model, ventilator duration (adjusted odds ratio 1.3 [95% CI 1.0-1.7], = .050) and weight (adjusted odds ratio 0.95 [95% CI 0.91-0.99], = .02) were associated with the use of postextubation respiratory support.
The majority of intubated subjects with pediatric ARDS received respiratory support postextubation, and a substantial proportion continued to require it up to hospital discharge.
在儿科急性呼吸窘迫综合征（ARDS）中，拔管后的呼吸支持可能用于支持正在恢复的呼吸系统，并促进及时、成功地脱离机械通气。本研究的目的是：（1）描述从拔管到出院期间儿科 ARDS 患者使用拔管后呼吸支持的情况；（2）确定拔管后呼吸支持的潜在风险因素；（3）为未来更大规模的研究提供初步数据。
本试点单中心前瞻性队列研究招募了儿科 ARDS 患者。记录患者呼吸状态直至出院，以及使用拔管后呼吸支持的情况及其随时间的变化。比较接受拔管后呼吸支持与未接受拔管后呼吸支持的患者，并比较不同儿科 ARDS 严重程度类别的患者使用拔管后呼吸支持的情况。多变量逻辑回归用于确定与使用拔管后呼吸支持相关的变量，包括氧合指数（OI）、呼吸机使用时间和体重。
共分析了 73 例儿科 ARDS 患者，中位年龄和 OI 分别为 4（0.6-10.5）岁和 7.3（4.9-12.7）。54/73（74%）例患者接受了拔管后呼吸支持：轻度、中度和重度儿科 ARDS 患者分别有 28/45（62.2%）、19/21（90.5%）和 7/7（100%）接受了拔管后呼吸支持（ =.01）。与未接受拔管后呼吸支持的患者相比，接受拔管后呼吸支持的患者 OI 更高[8.7（5.4-14）比 4.6（3.7-7）， <.001]，呼吸机使用时间更长[10（7-17）d 比 4（2-7）d， <.001]。在出院时，12/67（18.2%）幸存者接受了家庭呼吸支持（6 例患者在出院前死亡）。在多变量模型中，呼吸机使用时间（调整后的优势比 1.3[95%CI 1.0-1.7]， =.050）和体重（调整后的优势比 0.95[95%CI 0.91-0.99]， =.02）与使用拔管后呼吸支持相关。
大多数接受气管插管的儿科 ARDS 患者在拔管后接受了呼吸支持，其中相当一部分患者在出院前仍需要呼吸支持。
