在重症儿童中,非侵入性通风失败的预测因素
Alyson K Baker1, Andrew L Beardsley1, Brian D Leland1
1Division of Pediatric Critical Care, Riley Hospital for Children, Indiana University, Indianapolis, Indiana, United States.
Journal of pediatric intensive care
|August 11, 2023
概括
非侵入性通风 (NIV) 可以治疗儿科急性呼吸衰竭. 较高的氧气需求和呼吸率恶化的预测NIV失败,导致更长的重症监护室停留.
科学领域:
- 儿科重症监护医药 儿科重症监护医药
- 呼吸系统药物 呼吸系统药物
背景情况:
- 非侵入性通风 (NIV) 是急性呼吸衰竭的常见治疗方法.
- 大多数关于NIV使用的数据来自成人研究,因此需要专门针对儿科的研究.
- 确定儿童NIV失败的预测因素对于优化治疗和结果至关重要.
研究的目的:
- 在需要输管治疗的儿科患者中确定与NIV失败相关的临床预测因素.
- 评估NIV对儿童呼吸速率和氧气需求的影响.
- 为了确定影响儿童重症监护病房 (PICU) 住院时间的因素,为接受NIV治疗的患者.
主要方法:
- 在PICU中接受NIV治疗的148名儿科患者的回顾性观察性研究 (不包括术后化).
- 收集的数据包括患者的人口统计,并发症,呼吸衰竭病因和严重程度得分 (PRISM,P-POSSUM).
- 分析的重点是预测NIV失败 (需要输管),呼吸率变化和PICU停留时间的预测因素.
主要成果:
- 18%的患者 (27/148) 失败了NIV. 更高的入院儿科死亡风险 (PRISM) 和儿科物流器官功能障碍 (P-POSSUM) 评分与失败有关.
- 在NIV启动时更高的吸入氧 (FiO2) 分数和1小时和6小时后呼吸率恶化是NIV失败的显著预测因素.
- NIV失败与显著更长的PICU停留时间有关 (10.6天与2.8天).
结论:
- 非侵入性通风在治疗儿科患者急性呼吸衰竭方面是有效的.
- 临床预测NIV失败的预测因素包括更高的FiO2要求和缺乏改善或恶化的短视.
- 密切监测呼吸速率和氧化率的趋势是必不可少的,特别是在低血量儿童没有响应NIV.
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