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在儿科重症监护病房的支气管炎的呼吸系统支持实践
Jonathan H Pelletier1,2, Danielle E Maholtz1,2, Claire M Hanson1,2
1Division of Critical Care Medicine, Department of Pediatrics, Akron Children's Hospital, Akron, Ohio.
JAMA network open
|May 10, 2024
概括
从2013年到2022年,儿童重症监护室 (PICU) 支气管炎的入院人数显著增加,同时增加了高流量鼻腔管 (HFNC) 和非侵入性通风 (NIV) 的使用. 体重减轻和心脏病等因素与支持失败有关.
科学领域:
- 儿科重症监护医学 儿科重症监护医学
- 呼吸系统医学 呼吸系统医学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 患有支气管炎的儿童重症监护室 (PICU) 住院人数一直在增加.
- 这种增长与不断发展的非侵入性呼吸辅助实践之间的关联仍然不清楚.
研究的目的:
- 为了确定2013年至2022年期间的支气管炎PICU入院是否与使用高流量鼻腔管 (HFNC),非侵入性通风 (NIV) 和侵入性机械通风 (IMV) 的变化相关.
- 确定与HFNC和NIV在治疗支气管炎的成功和失败相关的因素.
主要方法:
- 一项横截面研究分析了2013-2022年27个PICU的33,816名支气管炎患者遭遇的情况.
- 线性回归评估了入口和通风使用的趋势;多变量后勤回归确定了影响HFNC/NIV成功和失败的因素.
主要成果:
- 支气管炎的PICU入院人数每年增加350次. HFNC使用量增加了242次/年,NIV使用量增加了126次/年;IMV使用量保持稳定.
- 成功使用HFNC从2013年的79.8%增加到2022年的84.0%;成功使用NIV在同一时期从73.2%增加到84.0%.
- 较低的体重,更高的儿科风险死亡率III分数,心脏病和非急诊室入院与HFNC和NIV失败的可能性更高有关.
结论:
- 2013年至2022年期间,肺炎的PICU入院人数增加了三倍,HFNC使用增加了4.8倍,NIV使用增加了5.8倍.
- 对支气管炎的HFNC和NIV支持协议的标准化对于减轻日益增加的资源压力至关重要.
- 进一步的研究是有必要的,以优化非侵入性呼吸支策略在小儿支气管炎的重症监护.
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