先天性心疾患を持つ小児の抜管後CPAP対従来の酸素化

Background: Congenital heart disease (CHD) is a leading contributor to pediatric morbidity and mortality worldwide. Postoperative respiratory complications, particularly reintubation, remain a critical concern following cardiac surgery in children. This study evaluates the effectiveness of early nasal CPAP in reducing reintubation rates and respiratory complications in children with CHD after extubation. Methods: A single-center randomized controlled trial was conducted from July 2022 to July 2024. A total of 264 children (≤3 years) undergoing cardiac surgery for CHD were randomized to either an intervention group (n = 132), receiving nasal CPAP (4 cm H₂O pressure, 5 L/min oxygen flow) immediately postextubation, or a control group (n = 132), receiving standard nasal cannula oxygen therapy. The primary outcome was reintubation within 48 h. Secondary outcomes included ventilation parameters (PaO₂, P_aCO2, S_pO2) and respiratory complications (eg, bronchospasm, hypoxemia). Results: The reintubation rate within 48 h was significantly lower in the CPAP group compared with the control group (12% vs 28%, risk ratio 0.41, 95% CI 0.22-0.76, P < .05). The CPAP group demonstrated marked improvements in ventilation parameters (PaO₂, P_aCO2, S_pO2) at 4, 8, and 12 h postextubation (P < .05 for all). Additionally, the incidence of respiratory complications was notably reduced in the intervention group (P < .05). Conclusions: Early application of nasal CPAP postextubation significantly reduces reintubation rates and enhances respiratory outcomes in children with CHD. This low-complexity CPAP shows promise for adoption in resource-limited settings, with potential cost advantages meriting further investigation.