Choi Jaeyoung, Park Esther, Park Hyejeong, Kang Danbee, Yang Jeong Hoon, Kim Hyunsoo, Cho Juhee, Cho Joongbum
Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Department of Pediatrics, Jeonbuk National University Children's Hospital, Jeonju, Republic of Korea.
PLoS One. 2024 Dec 13;19(12):e0315736. doi: 10.1371/journal.pone.0315736. eCollection 2024.
High-flow nasal cannula (HFNC) therapy has gained popularity in the pediatric intensive care unit (PICU). However, the nationwide effect of HFNC on mechanical ventilation duration has not been studied.
We retrospectively analyzed pediatric patients (28 days to 17 years old) admitted to tertiary ICUs for respiratory support from 2012 to 2019 using the Korean National Health Insurance database. Pre-/post-HFNC periods were defined as the 12 months before and after the application of HFNC in any hospital, respectively, allowing a 6-month transition period. Mechanical ventilation duration and ventilator-free days during these two periods were compared using a multivariable regression model.
Using data from 46 hospitals, 4,705 and 4,864 respective pre-/post-HFNC period patients were evaluated. During the post-HFNC period, 14.8% of patients were treated by HFNC, and 67.1% were treated using invasive mechanical ventilation. In adjusted analysis, mechanical ventilation duration was reduced by 0.99 days (confidence interval [CI]: -1.86, -0.12). The duration was significantly reduced by 17.81 days (CI: -35.46, -0.16) among patients whose ventilation duration was longer than 28 days. In subgroup analysis, mechanical ventilation duration was reduced by 1.49 days (CI: -2.78, -0.19) in the overall surgical group and 6.71 days (CI: -11.71, - 1.71) in the neurologic subgroup. Ventilator-free days were increased only in the overall surgical group, by 0.31 days (CI: 0.01, 0.61).
Application of HFNC to PICU patients could reduce mechanical ventilation duration, especially in patients requiring prolonged mechanical ventilator support or in post-operative patients.
高流量鼻导管（HFNC）治疗在儿科重症监护病房（PICU）中越来越受欢迎。然而，HFNC对机械通气时间的全国性影响尚未得到研究。
我们使用韩国国民健康保险数据库，对2012年至2019年入住三级重症监护病房接受呼吸支持的儿科患者（28天至17岁）进行了回顾性分析。HFNC治疗前后时期分别定义为在任何医院应用HFNC之前和之后的12个月，允许有6个月的过渡期。使用多变量回归模型比较这两个时期的机械通气时间和无呼吸机天数。
利用46家医院的数据，分别对4705例和4864例HFNC治疗前后时期的患者进行了评估。在HFNC治疗后时期，14.8%的患者接受了HFNC治疗，67.1%的患者接受了有创机械通气治疗。在调整分析中，机械通气时间缩短了0.99天（置信区间[CI]：-1.86，-0.12）。在通气时间超过28天的患者中，通气时间显著缩短了17.81天（CI：-35.46，-0.16）。在亚组分析中，总体手术组的机械通气时间缩短了1.49天（CI：-2.78，-0.19），神经亚组缩短了6.71天（CI：-11.71，-1.71）。仅总体手术组的无呼吸机天数增加了0.31天（CI：0.01，0.61）。
将HFNC应用于PICU患者可缩短机械通气时间，尤其是在需要长时间机械通气支持的患者或术后患者中。
