呼吸道合胞病毒与美国儿科重症监护利用情况
Respiratory Syncytial Virus and US Pediatric Intensive Care Utilization.
机构信息
Division of Pediatric Critical Care Medicine, Children's National Hospital, Washington, DC.
Now with Division of Pediatric Critical Care Medicine, Cohen Children's Medical Center, New York, New York.
出版信息
JAMA Netw Open. 2024 Oct 1;7(10):e2440997. doi: 10.1001/jamanetworkopen.2024.40997.
IMPORTANCE
Bronchiolitis is the most common diagnosis necessitating respiratory support and pediatric intensive care, and respiratory syncytial virus (RSV) is the most common cause of bronchiolitis. In 2023, the monoclonal antibody nirsevimab and the maternal RSVpreF vaccine were implemented to prevent RSV in infants.
OBJECTIVE
To determine the potential association of novel RSV prevention strategies with pediatric intensive care unit (ICU) utilization.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cross-sectional study examined US pediatric ICU encounters with and without RSV from January 1, 2017, to June 1, 2023. Data were from Oracle Cerner RealWorld Data, a national electronic health record database. All children (aged >1 day and <18 years) admitted to an ICU during the study period were included in the analysis. Statistical analysis was performed from February to May 2024.
MAIN OUTCOMES AND MEASURES
The primary outcomes were ICU encounters with RSV and ICU encounters with RSV eligible for RSV prevention.
RESULTS
There were 119 782 ICU encounters from 53 hospitals; 65 757 encounters (54.9%) were male; median (IQR) age was 4.5 (1.1-12.5) years, median (IQR) ICU length of stay was 1.8 (1.0-3.9) days; 13 702 ICU encounters (11.4%) had RSV, of which 38.6% (5217) were eligible for prevention (4.4% of total ICU encounters). Encounters with RSV accounted for 21.1% (109 334) of ICU days, of which 43.8% (47 888) were eligible for prevention (9.2% of total ICU days). Encounters with RSV were associated with a greater use of positive pressure ventilation (4074 [29.7%] vs 18 821 [17.7%]; P < .001) and vasoactive medications (3057 [22.3%] vs 18 570 [17.5%]; P < .001) compared with those without RSV.
CONCLUSIONS AND RELEVANCE
The findings of this retrospective cross-sectional study of RSV and US pediatric intensive care utilization suggest that if 65% to 85% of eligible children received RSV prevention, an estimated 2.1% to 2.8% reduction in pediatric ICU encounters and an estimated 4.5% to 5.9% reduction in pediatric ICU days could be achieved.
重要性
细支气管炎是最常见的需要呼吸支持和儿科重症监护的诊断，呼吸道合胞病毒（RSV）是细支气管炎最常见的病因。2023 年，单克隆抗体 nirsevimab 和 RSVpreF 母亲疫苗被用于预防婴儿 RSV。
目的
确定新型 RSV 预防策略与儿科重症监护病房（PICU）利用之间的潜在关联。
设计、设置和参与者：本回顾性横断面研究检查了 2017 年 1 月 1 日至 2023 年 6 月 1 日期间美国 PICU 出现 RSV 和符合 RSV 预防条件的 ICU 就诊情况。数据来自 Oracle Cerner RealWorld Data，这是一个国家电子健康记录数据库。所有在研究期间入住 ICU 的（年龄>1 天至<18 岁）儿童均纳入分析。统计分析于 2024 年 2 月至 5 月进行。
主要结局和措施
主要结局为 RSV 引起的 ICU 就诊和符合 RSV 预防条件的 RSV 引起的 ICU 就诊。
结果
来自 53 家医院的 119782 例 ICU 就诊；65757 例（54.9%）为男性；中位（IQR）年龄为 4.5（1.1-12.5）岁，中位（IQR）ICU 住院时间为 1.8（1.0-3.9）天；13702 例 ICU 就诊（11.4%）有 RSV，其中 38.6%（5217 例）符合预防条件（占总 ICU 就诊的 4.4%）。RSV 引起的就诊占 ICU 日数的 21.1%（109334 例），其中 43.8%（47888 例）符合预防条件（占 ICU 日数的 9.2%）。与无 RSV 就诊相比，RSV 就诊与更频繁地使用正压通气（4074 例[29.7%]与 18821 例[17.7%]；P<0.001）和血管活性药物（3057 例[22.3%]与 18570 例[17.5%]；P<0.001）相关。
结论和相关性
这项关于 RSV 和美国儿科重症监护利用的回顾性横断面研究的结果表明，如果 65%至 85%符合条件的儿童接受 RSV 预防，预计儿科 ICU 就诊人数将减少 2.1%至 2.8%，儿科 ICU 日数将减少 4.5%至 5.9%。
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