Miller Andrew G, Kumar Karan R, Adagarla Bhargav S, Haynes Kaitlyn E, Gates Rachel M, Muddiman Jeanette L, Heath Travis S, Allareddy Veerajalandhar, Rotta Alexandre T
Mr Miller is affiliated with Division of Pediatric Critical Care Medicine, Duke University Medical Center, Durham, North Carolina; and Respiratory Care Services, Duke University Medical Center, Durham, North Carolina.
Dr Kumar is affiliated with 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.
Respir Care. 2025 Feb;70(2):161-169. doi: 10.4187/respcare.11935. Epub 2024 Jul 16.
Respiratory failure in infants is a common reason for admission to the pediatric ICU (PICU). Although high-flow nasal cannula (HFNC) is the preferred first-line treatment at our institution, some infants require CPAP or noninvasive ventilation (NIV). Here we report our experience using CPAP/NIV in infants <10 kg. We conducted a retrospective review of infants <10 kg treated with CPAP/NIV in our PICUs between July 2017-May 2021 in the initial phase of treatment. Demographic, support type and settings, vital signs, pulse oximetry, and intubation data were extracted from the electronic health record. We compared subjects successfully treated with CPAP/NIV with those who required intubation. We studied 62 subjects with median (interquartile range) age 96 [6.5-308] d and weight 4.5 (3.4-6.6) kg. Of these, 22 (35%) required intubation. There were no significant differences in demographics, medical history, primary interface, pre-CPAP/NIV support, and device used to deliver CPAP/NIV. HFNC was used in 57 (92%) subjects before escalation to CPAP/NIV. Subjects who failed CPAP/NIV were less likely to have bronchiolitis (27% vs 60%, = .040), less likely to be discharged from the hospital to home (68% vs 93%, = .02), had a longer median hospital length of stay (LOS) (26.9 [21-50.5] d vs 10.4 [5.6-28.4] d, = .002), and longer median ICU LOS (14.6 [7.9-25.2] d vs 5.8 [3.8-12.4] d, = .004). Initial vital signs and F were similar, but S was lower and F higher at 6 h and 12 h after support initiation for subjects who failed CPAP/NIV. Initial CPAP/NIV settings were similar, but subjects who failed CPAP/NIV had higher maximum and final inspiratory/expiratory pressure. Most infants who failed initial HFNC support were successfully managed without intubation using NIV or CPAP. Bronchiolitis was associated with a lower rate of CPAP/NIV failure, whereas lower S and higher F levels were associated with higher rates of intubation.
婴儿呼吸衰竭是入住儿科重症监护病房（PICU）的常见原因。尽管高流量鼻导管（HFNC）是我们机构首选的一线治疗方法，但一些婴儿仍需要持续气道正压通气（CPAP）或无创通气（NIV）。在此，我们报告我们在体重<10 kg婴儿中使用CPAP/NIV的经验。我们对2017年7月至2021年5月期间在我们PICU接受CPAP/NIV治疗的初始阶段体重<10 kg的婴儿进行了回顾性研究。从电子健康记录中提取人口统计学、支持类型和设置、生命体征、脉搏血氧饱和度和插管数据。我们将成功接受CPAP/NIV治疗的受试者与需要插管的受试者进行了比较。我们研究了62名受试者，中位（四分位间距）年龄为96 [6.5 - 308]天，体重为4.5（3.4 - 6.6）kg。其中，22名（35%）需要插管。在人口统计学、病史、主要接口、CPAP/NIV前支持以及用于提供CPAP/NIV的设备方面没有显著差异。在升级至CPAP/NIV之前，57名（92%）受试者使用了HFNC。CPAP/NIV治疗失败的受试者患细支气管炎的可能性较小（27%对60%，P = 0.040），从医院出院回家的可能性较小（68%对93%，P = 0.02），中位住院时间（LOS）较长（26.9 [21 - 50.5]天对10.4 [5.6 - 28.4]天，P = 0.002），中位ICU住院时间较长（14.6 [7.9 - 25.2]天对5.8 [3.8 - 12.4]天，P = 0.004）。初始生命体征和F相似，但CPAP/NIV治疗失败的受试者在支持开始后6小时和12小时时S较低而F较高。初始CPAP/NIV设置相似，但CPAP/NIV治疗失败的受试者具有更高的最大和最终吸气/呼气压力。大多数初始HFNC支持失败的婴儿使用NIV或CPAP成功管理而无需插管。细支气管炎与CPAP/NIV失败率较低相关，而较低的S和较高的F水平与较高的插管率相关。
