儿童长期机械通风的定义,风险因素和结果分析
Ruonan Chen1, Yanling Liu2, Hongxing Dang1
1Department of PICU Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China.
Pediatric pulmonology
|May 10, 2024
概括
定义儿童长期机械通风 (PMV) 为13天或更长时间至关重要. 这一门有助于识别较高的死亡风险,输出管失败和延长住院时间,指导更好的临床策略.
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
- 临床结果研究研究
背景情况:
- 长时间的机械通风 (PMV) 对儿科患者构成重大风险.
- 缺少儿童PMV的标准化定义,阻碍了一致的临床管理和研究.
- 确定PMV的最佳时间值对于风险分层和结果预测至关重要.
研究的目的:
- 确定在儿科患者中定义PMV的时间值.
- 调查与儿童发展PMV相关的风险因素.
- 分析与不同持续时间的机械通风 (MV) 相关的临床结果.
主要方法:
- 一项前性队列研究包括382名儿童 (29天-18岁),每天需要MV>6小时.
- 根据MV持续时间 (2-7,8-14,15-21,21-30,>30天) 分组患者,以评估输出失败,死亡率,气管切割和住院时间.
- 尤登指数确定了PMV的MV持续时间值;后勤回归分析了风险因素.
主要成果:
- 定义PMV的最佳值是12.5天,基于输出失败和/或1个月死亡率.
- 输出失败率从10.4% (8-14天) 显著增加到超过41%的MV持续时间为15天或更长.
- PMV的危险因素包括较高的PIM-3分数,年龄相应的体重低,呼吸困难,血液动力学不稳定性和输血.
结论:
- 在儿童中,机械通风持续≥13天与显著增加的死亡率,输出失败,气管切割率和医疗保健利用率有关.
- 对于儿科患者的PMV的一个建议定义是机械通风≥13天,特别是在呼吸系统疾病中.
- 这一定义有助于临床医生进行风险评估,治疗计划,并向家庭提供预后信息.
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