Asif Hassaan, McNeer Jennifer L, Ghanayem Nancy S, Cursio John F, Kane Jason M
Pritzker School of Medicine, University of Chicago, Chicago, IL.
Department of Pediatrics, Section of Pediatric Hematology/Oncology, University of Utah, Primary Children's Hospital, Salt Lake City, UT.
Crit Care Explor. 2024 Apr 9;6(4):e1076. doi: 10.1097/CCE.0000000000001076. eCollection 2024 Apr.
To characterize trends in noninvasive ventilation (NIV) and invasive mechanical ventilation (IMV) use over time in children with hematologic malignancy admitted to the PICU with acute respiratory failure (ARF), and to identify risk factors associated with NIV failure requiring transition to IMV.
Retrospective cohort analysis using the Virtual Pediatric Systems (VPS, LLC) between January 1, 2010 and December 31, 2019.
One hundred thirteen North American PICUs participating in VPS.
Two thousand four hundred eighty children 0-21 years old with hematologic malignancy admitted to participating PICUs for ARF requiring respiratory support.
None.
There were 3013 total encounters, of which 868 (28.8%) received first-line NIV alone (NIV only), 1544 (51.2%) received first-line IMV (IMV only), and 601 (19.9%) required IMV after a failed NIV trial (NIV failure). From 2010 to 2019, the NIV only group increased from 9.6% to 43.1% and the IMV only group decreased from 80.1% to 34.2% ( < 0.001). The NIV failure group had the highest mortality compared with NIV only and IMV only (36.6% vs. 8.1%, vs. 30.5%, < 0.001). However, risk-of-mortality (ROM) was highest in the IMV only group compared with NIV only and NIV failure (median Pediatric Risk of Mortality III ROM 8.1% vs. 2.8% vs. 5.5%, < 0.001). NIV failure patients also had the longest median PICU length of stay compared with the other two study groups (15.2 d vs. 6.1 and 9.0 d, < 0.001). Higher age was associated with significantly decreased odds of NIV failure, and diagnosis of non-Hodgkin lymphoma was associated with significantly increased odds of NIV failure compared with acute lymphoid leukemia.
For children with hematologic malignancy admitted to the PICU with ARF, NIV has replaced IMV as the most common initial therapy. NIV failure rate remains high with high-observed mortality despite lower PICU admission ROM.
描述入住儿科重症监护病房（PICU）且患有血液系统恶性肿瘤并伴有急性呼吸衰竭（ARF）的儿童，随着时间推移无创通气（NIV）和有创机械通气（IMV）的使用趋势，并确定与NIV失败而需要转为IMV相关的危险因素。
使用虚拟儿科系统（VPS，LLC）进行回顾性队列分析，时间跨度为2010年1月1日至2019年12月31日。
113家参与VPS的北美PICU。
2480名0至21岁患有血液系统恶性肿瘤的儿童，因ARF入住参与研究的PICU并需要呼吸支持。
无。
总共3013次诊疗，其中868例（28.8%）仅接受一线NIV（仅NIV组），1544例（51.2%）接受一线IMV（仅IMV组），601例（19.9%）在NIV试验失败后需要IMV（NIV失败组）。从2010年到2019年，仅NIV组从9.6%增至43.1%，仅IMV组从80.1%降至34.2%（P<0.001）。与仅NIV组和仅IMV组相比，NIV失败组死亡率最高（36.6%对8.1%对30.5%，P<0.001）。然而，与仅NIV组和NIV失败组相比，仅IMV组的死亡风险（ROM）最高（儿科死亡风险III级中位数ROM 8.1%对2.8%对5.5%，P<0.001）。与其他两个研究组相比，NIV失败患者的PICU中位住院时间也最长（15.2天对6.1天和9.0天，P<0.001）。年龄较大与NIV失败几率显著降低相关，与急性淋巴细胞白血病相比，非霍奇金淋巴瘤的诊断与NIV失败几率显著增加相关。
对于因ARF入住PICU的血液系统恶性肿瘤儿童，NIV已取代IMV成为最常见的初始治疗方法。尽管PICU入院时ROM较低，但NIV失败率仍然很高，死亡率也很高。
