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在住院治疗前使用吸入式皮质类固醇可能对患有直接肺损伤的儿童有保护作用
Elizabeth Landzberg1, Garrett Keim2, Nadir Yehya2
1Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania, Philadelphia, PA.
CHEST critical care
|September 20, 2024
概括
吸入性皮质类固醇 (ICS) 可能会减少直接肺损伤 (DLI) 的儿童的呼吸衰竭. 这种保护作用在有喘史的儿童中更为明显.
科学领域:
- 儿科肺病学 儿科肺病学
- 关键护理医学 关键护理医学
- 药理学 药理学是指药理学的学科.
背景情况:
- 由于副作用,系统性皮质类固醇在急性呼吸衰竭中具有不确定的益处.
- 吸入性皮质类固醇 (ICS) 提供局部抗炎作用.
- 在患有直接肺损伤 (DLI) 的儿童中,ICS的保护作用尚未得到充分证实.
研究的目的:
- 为了调查是否在住院之前给患有DLI的儿童开处方ICS,降低了进展到呼吸衰竭的几率.
- 评估在入院前使用ICS和在患有DLI的儿童中需要输管或非侵入性呼吸辅助 (NRS) 之间的关联.
主要方法:
- 追溯性,单中心队列研究,对儿童提出ED与DLI.
- 在住院治疗之前,审查了ICS使用的药物记录.
- 结果包括输管 (初级) 和NRS (二级),并对混因子进行调整,并对系统性皮质类固醇使用进行敏感性分析.
主要成果:
- 使用ICS与输管率 (aOR,0.46) 和NRS (aOR,0.45) 的几率明显降低.
- ICS与NRS的保护性关联基于喘病史而有所不同 (P = .04的相互作用).
- ICSs主要在有喘病史的儿童中表现出保护作用.
结论:
- 在入院前使用ICS可以保护患有DLI的儿童免受呼吸衰竭.
- ICSs的疗效可能有所差异,在有喘病史的儿童中可能更有效.
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