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呼吸器支用于儿科关键性喘的机构变异性:一个多中心回顾性研究
Colin M Rogerson1, Benjamin R White2, Michele Smith3
1Division of Pediatric Critical Care Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
Annals of the American Thoracic Society
|January 19, 2024
概括
高容量的儿科重症监护病房越来越多地使用非侵入性通风来治疗严重的喘,而高流量鼻和侵入性机械通风的使用却在减少. 这些呼吸辅助方法的使用总体上正在增加.
科学领域:
- 儿科重症监护医学 儿科重症监护医学
- 呼吸系统疗法 呼吸系统疗法
- 医疗保健服务研究 医疗服务研究
背景情况:
- 在美国,每年有超过2万名儿童因喘住院治疗,这凸显了严重的公共卫生问题.
- 现有的小儿喘治疗指南缺乏关于最佳呼吸辅助器械的强有力的证据.
- 呼吸辅助方式的使用存在变化,需要对影响因素进行评估.
研究的目的:
- 评估对患有关键性喘的儿童应用呼吸支方式的机构和时间变化.
- 确定医院容量和入院年对选择呼吸辅助方法的影响.
主要方法:
- 一项回顾性队列研究分析了2012年至2021年期间来自163个儿科重症监护病房的77,115例患者接触.
- 来自虚拟儿科系统数据库的数据包括2岁以上患有初级喘或状态喘诊断的儿童.
- 后勤回归和时间序列分析检查了与机构体积和时间相关的高流量鼻腔管 (HFNC),CPAP,NIV和IMV的使用.
主要成果:
- 在使用HFNC,CPAP,NIV和IMV方面观察到显著的机构变异.
- 更高的机构患者数量与NIV和CPAP的使用增加以及HFNC和IMV的使用减少相关.
- 在过去的十年中,HFNC,CPAP和NIV的使用大幅增加,而IMV的使用保持稳定.
结论:
- 高容量儿科中心正在为严重的喘病例更频繁地采用非侵入性正压通风.
- 有一种趋势是,HFNC和IMV在较高体积的中心使用率下降.
- 在过去的十年中,HFNC,CPAP和NIV用于儿科关键喘的应用显著增加.
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