在呼吸衰竭的小婴儿初始治疗阶段的非侵入性通风或CPAP
Andrew G Miller1, Karan R Kumar2, Bhargav S Adagarla3
1Mr Miller is affiliated with Division of Pediatric Critical Care Medicine, Duke University Medical Center, Durham, North Carolina; and Respiratory Care Services, Duke University Medical Center, Durham, North Carolina.
Respiratory care
|July 16, 2024
概括
大多数10公斤以下的婴儿未能获得高流量鼻腔管 (HFNC) 支持,已成功使用持续正气道压力 (CPAP) 或非侵入性通风 (NIV) 治疗. 支气管炎预测了成功,而较低的氧和预测了失败.
科学领域:
- 儿科 儿科 儿科
- 临界护理医学 临界护理医学
- 呼吸系统医学 呼吸系统医学
背景情况:
- 呼吸衰竭是婴儿重症监护室 (PICU) 入院的常见原因之一.
- 高流量鼻腔管 (HFNC) 是主要的治疗方法,但有些婴儿需要持续的正气道压力 (CPAP) 或非侵入性通风 (NIV).
- 这项研究研究了CPAP/NIV在体重小于10公斤的婴儿中的使用情况.
研究的目的:
- 评估CPAP/NIV在初始HFNC治疗失败的10公斤以下婴儿的有效性.
- 为了确定与CPAP/NIV失败和随后的输入管相关的因素.
主要方法:
- 在2017年7月至2021年5月期间接受CPAP/NIV治疗的10公斤以下婴儿的回顾性评估.
- 收集的数据包括人口统计,支持设置,生命体征,脉冲氧计和输管状态.
- 用CPAP/NIV成功治疗的婴儿与需要输管治疗的婴儿之间的比较.
主要成果:
- 研究了62名婴儿;35%需要输管.
- 群体之间没有发现人口统计或初始支持的显著差异.
- CPAP/NIV失败与更低的支气管炎发病率 (27%与60%相比),更低的住院出院率 (68%与93%相比) 和更长的住院时间 (26.9与10.4天) 和ICU (14.6与5.8天) 相关.
- 较低的SpO2和较高的FiO2在开始后6小时和12小时预测失败.
结论:
- CPAP/NIV对于大多数体重小于10公斤的婴儿是有效的,如果初始的HFNC支持失败.
- 支气管炎与更好的结果有关,而较低的氧化预测需要输管治疗.
- 这支持使用CPAP/NIV作为在这个人群中机械通风之前的关键步骤.
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