Mortamet Guillaume, Milési Christophe, Cassibba Julie, Ego Anne, Sourd Dimitri, Guichoux Julie, Piloquet Jean-Eudes, Baudin Florent
Pediatric Intensive Care Unit, Grenoble-Alps University Hospital, Grenoble, France.
HP2 Laboratory, INSERM U1300, Grenoble-Alps University, Grenoble, France.
Pediatr Pulmonol. 2025 Apr;60(4):e71108. doi: 10.1002/ppul.71108.
The aim is to describe weaning procedures, weaning failure rates, and predictors and consequences of weaning failure in infants admitted to pediatric intensive care units (PICUs) for severe bronchiolitis.
This is a multicenter prospective observational cohort study in five PICUs in French university hospitals. Consecutive infants aged 3 days to 6 months admitted between November 2020 and April 2022 with a clinical diagnosis of severe bronchiolitis requiring noninvasive ventilatory support by bilevel positive airway pressure (BiPAP), continuous positive airway pressure (CPAP), or high-flow nasal cannula (HFNC).
Demographic and clinical data were collected prospectively. Weaning strategies were classified as direct, HFNC for de-escalation, and gradual with decreasing support levels. Multivariate analysis was performed to identify independent predictors of weaning failure. Of the 135 included patients (median age 1 [1-2] months), 60 (44%), 49 (36%), and 26 (19%) were managed by HFNC-based, direct, and gradual weaning, respectively. Bronchiolitis severity was similar in the three groups. By multivariate analysis, predictors of weaning failure was gradual weaning (odds ratio, 10.56 [2.87-38.86], p < 0.01), while apnea at admission (0.26 [0.07-0.96], p = 0.04) and younger age (0.44 [0.23-0.84], p = 0.02) were protective factors. PICU length of stay was shorter with HFNC-based weaning (3.8 [1.9-5.4] days vs. 4.3 [3.0-6.9] and 5.1 [3.8-7.4] with direct and gradual weaning, respectively, p = 0.02).
Among patients with severe bronchiolitis, a weaning strategy using HFNC for de-escalation was associated with shorter PICU stays. Whether this method also decreases the risk of weaning failure deserves investigation.
目的是描述入住儿科重症监护病房（PICUs）的重症细支气管炎婴儿的撤机程序、撤机失败率以及撤机失败的预测因素和后果。
这是一项在法国大学医院的五个PICUs进行的多中心前瞻性观察队列研究。2020年11月至2022年4月期间连续收治的年龄在3天至6个月之间、临床诊断为重症细支气管炎且需要通过双水平气道正压通气（BiPAP）、持续气道正压通气（CPAP）或高流量鼻导管（HFNC）进行无创通气支持的婴儿。
前瞻性收集人口统计学和临床数据。撤机策略分为直接撤机、使用HFNC进行降级撤机以及逐渐降低支持水平的撤机。进行多变量分析以确定撤机失败的独立预测因素。在纳入的135例患者（中位年龄1[1 - 2]个月）中，分别有60例（44%）、49例（36%）和26例（19%）采用基于HFNC的撤机、直接撤机和逐渐撤机方式进行管理。三组细支气管炎严重程度相似。通过多变量分析，撤机失败的预测因素是逐渐撤机（比值比，10.56[2.87 - 38.86]，p < 0.01），而入院时的呼吸暂停（0.26[0.07 - 0.96]，p = 0.04）和较年轻的年龄（0.44[0.23 - 0.84]，p = 0.02）是保护因素。基于HFNC的撤机患者在PICU的住院时间较短（3.8[1.9 - 5.4]天，而直接撤机和逐渐撤机分别为4.3[3.0 - 6.9]天和5.1[3.8 - 7.4]天，p = 0.02）。
在重症细支气管炎患者中，使用HFNC进行降级撤机的策略与较短的PICU住院时间相关。这种方法是否也能降低撤机失败的风险值得研究。
