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为患有血液恶性病和急性呼吸衰竭的儿童提供一线呼吸支持
Hassaan Asif1, Jennifer L McNeer2, Nancy S Ghanayem3
1Pritzker School of Medicine, University of Chicago, Chicago, IL.
Critical care explorations
|April 11, 2024
概括
非侵入性通风 (NIV) 现在是小儿急性呼吸衰竭 (ARF) 的主要治疗方法. 然而,NIV失败仍然是一个重大问题,导致高死亡率和长时间的PICU停留.
科学领域:
- 儿科重症监护医学 儿科重症监护医学
- 血液学-瘤学 血液学-瘤学
- 呼吸系统医学 呼吸系统医学
背景情况:
- 急性呼吸衰竭 (ARF) 是患有血液性恶性瘤的儿童的一个关键并发症.
- 选择的呼吸辅助,包括非侵入性通风 (NIV) 和侵入性机械通风 (IMV),显著影响结果.
- 了解这一弱势群体的通风策略的趋势和风险因素对于优化护理至关重要.
研究的目的:
- 分析使用NIV与IMV的时间趋势,用于在儿科重症监护室 (PICU) 患有ARF的血液恶性瘤的儿科患者.
- 确定NIV失败的预测因素,这些预测因素需要升级到IMV.
- 为了比较不同通风策略的结果,包括死亡率和停留时间.
主要方法:
- 追溯对2,480名患有血液性恶性瘤和需要呼吸辅助的ARF的儿童 (0-21岁) 的队列分析.
- 数据是从虚拟儿科系统 (VPS) 数据库中提取的,涵盖了2010年至2019年的113个北美PICU.
- 患者被分为三个组:单独NIV,单独IMV和需要IMV的NIV失败.
主要成果:
- 从2010年到2019年,NIV作为一线治疗从9.6%显著增加到43.1%,而IMV作为一线治疗从80.1%降低到34.2%.
- 与仅使用NIV (8.1%) 和仅使用IMV (30.5%) 相比,NIV失败组的死亡率最高 (36.6%).
- 高龄与NIV失败的几率降低有关,而非霍奇金淋巴瘤诊断与急性淋巴白血病相比,增加了这些几率.
结论:
- 非侵入性通风已成为在PICU中患有ARF的小儿血液恶性瘤患者的主要初始呼吸支策略.
- 尽管转向NIV,但仍然存在大量的NIV失败率,与观察到的高死亡率和长时间的PICU停留时间有关.
- 风险分层和谨慎的患者选择对于减轻与这种人群中NIV失败相关的风险至关重要.
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