在儿科急性呼吸衰竭中实施非侵入性神经调节呼吸辅助:一项受控的前后质量改善研究
Giovanna Chidini1, Daniele De Luca2, Edoardo Calderini3
1Pediatric Intensive Care Unit, Department of Anesthesia, Intensive Care and Emergency, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy. giovanna.chidini@policlinico.mi.it.
Journal of anesthesia, analgesia and critical care
|June 29, 2023
概括
与压力支通风相比,神经调节的呼吸辅助 (NAVA) 在急性低血压呼吸衰竭的儿童中显著降低了输管率和停留时间. 这种新的方法在儿科重症监护中显示出有前途的临床结果.
科学领域:
- 儿科重症监护医学 儿科重症监护医学
- 呼吸系统生理学 呼吸系统生理学
- 机械通风机械通风机械通风
背景情况:
- 非侵入性神经调整呼吸辅助 (NIV-NAVA) 显示,儿童的患者呼吸器相互作用得到改善.
- 儿科NIV-NAVA临床结局数据以前没有.
- 儿童急性缺血性呼吸衰竭 (AHRF) 需要有效的呼吸系统支持.
研究的目的:
- 为了比较NIV-NAVA与非侵入性压力支 (NIV-PS) 在患有AHRF的儿科患者的临床结果.
- 评估NIV-NAVA对输管率和其他关键临床结果的影响.
- 评估NIV-NAVA在改善重症儿童生理参数方面的有效性.
主要方法:
- 一个单一的中心,前后研究设计.
- 34名接受NIV-PS治疗的患者队列与30名接受NIV-NAVA治疗的患者队列的比较.
- 主要终点:输管率.输管率. 二级终点:机械通风的持续时间,侵入性设备的使用,医院感染,住院时间和生理参数.
主要成果:
- 在NIV-NAVA组中,输管率较低 (p = 0.006).
- 通过NIV-NAVA,侵袭性设备的需求减少 (p = 0.032) 和通过呼吸机获得的肺炎的发病率降低 (p = 0.004).
- 较短的儿科重症监护室 (PICU) 和住院时间 (LOS) 对于NIV-NAVA患者 (p = 0.032和p = 0.013,分别).
- 改善氧化 (PaO2:FiO2),降低PaCO2,呼吸率 (RR) 和心率 (HR) 在2小时内与NIV-NAVA.
结论:
- 在儿科AHRF中早期实施NIV-NAVA与更低的输管率有关.
- 在儿童患者中,NIV-NAVA显示了减少PICU和医院LOS的潜力.
- 需要进一步的研究来验证这些关于NIV-NAVA疗效的初步发现.
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