Zhang Zhengzheng, Cai Xiaodi, Ming Meixiu, Huang Li, Liu Chengjun, Ren Hong, Qu Dong, Gao Hengmiao, Cheng Yibing, Zhang Furong, Yang Zihao, Xu Wei, Miao Hongjun, Liu Pan, Liu Yuxin, Lu Guoping, Chen Weiming
Pediatric Intensive Care Unit, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai, China.
Department of Pediatric Intensive Care Unit, National Children's Medical Center for South Central Region, Guangzhou Women and Children's Medical Center, Guangzhou, China.
Front Pediatr. 2024 May 30;12:1413094. doi: 10.3389/fped.2024.1413094. eCollection 2024.
To evaluate the incidence, outcome, and prognostic factors of prolonged mechanical ventilation (PMV) in children in Mainland China.
A prospective study was conducted in 11 pediatric intensive care units (PICUs) from May 1, 2021, to April 30, 2022. All pediatric patients on mechanical ventilation meeting the criteria for PMV were included in the study.
Out of 5,292 patients receiving mechanical ventilation, 278 children met the criteria for PMV (5.3%). After excluding case with incomplete data or lost to follow-up, the study included 250 patients. Among them, 115 were successfully weaned from mechanical ventilation, 90 died, and 45 were still on mechanical ventilation. The 6-month survival rate was 64%. The primary associated conditions of PMV were lower airway diseases (36%), central nervous system diseases (32%), and neuromuscular diseases (14%). The stepwise multiple logistic regression analysis indicated that the utilization of vasoactive agents and an elevated pediatric logistic organ dysfunction-2 (PELOD-2) score on the day of PMV diagnosis were significantly associated with an increased of PMV death. Specifically, the odds ratio (OR) for vasoactive agent use was 2.86; (95% CI: 0.15-0.84; = 0.018), and for the PELOD-2 score, it was 1.37; 95% CI: 1.17-1.61; < .001). Conversely, early rehabilitation intervention was negatively associated with the risk of PMV death (OR = 0.45; 95% CI: 0.22-0.93; = .032). Furthermore, the tracheotomy timing emerged as an independent predictor of failure to wean from PMV, with an OR of 1.08, (95% CI: 1.01-1.16; .030).
The study revealed a 5.3% incidence of PMV in children requiring mechanical ventilation in China. The use of vasoactive agents and a higher PELOD-2 score at PMV diagnosis were significantly associated with an increased risk of PMV death, whereas early rehabilitation intervention was identified as crucial for improving patient outcomes. The timing of tracheostomy was identified as a high-risk factor for failure to wean from mechanical ventilation.
评估中国大陆儿童长时间机械通气（PMV）的发生率、结局及预后因素。
于2021年5月1日至2022年4月30日在11个儿科重症监护病房（PICU）进行了一项前瞻性研究。所有符合PMV标准的接受机械通气的儿科患者均纳入本研究。
在5292例接受机械通气的患者中，278例儿童符合PMV标准（5.3%）。排除数据不完整或失访的病例后，本研究纳入250例患者。其中，115例成功脱机，90例死亡，45例仍在接受机械通气。6个月生存率为64%。PMV的主要相关疾病为下呼吸道疾病（36%）、中枢神经系统疾病（32%）和神经肌肉疾病（14%）。逐步多因素logistic回归分析表明，PMV诊断当天使用血管活性药物和儿科逻辑器官功能障碍-2（PELOD-2）评分升高与PMV死亡风险增加显著相关。具体而言，使用血管活性药物的比值比（OR）为2.86；（95%CI：0.15 - 0.84；P = 0.018），PELOD-2评分的OR为1.37；95%CI：1.17 - 1.61；P < 0.001）。相反，早期康复干预与PMV死亡风险呈负相关（OR = 0.45；95%CI：0.22 - 0.93；P = 0.032）。此外，气管切开时机是PMV脱机失败的独立预测因素，OR为1.08，（95%CI：1.01 - 1.16；P = 0.030）。
该研究显示中国需要机械通气的儿童中PMV发生率为5.3%。PMV诊断时使用血管活性药物和较高的PELOD-2评分与PMV死亡风险增加显著相关，而早期康复干预对改善患者结局至关重要。气管切开时机被确定为机械通气脱机失败的高危因素。
