接近生命终点的儿童的机械通风:一个PHIS研究,2010-2019年
Deirdre F Puccetti1,2,3, Steven J Staffa1, Jeffrey P Burns1,3
1Divisions of aCritical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine.
Hospital pediatrics
|November 30, 2024
概括
侵入性和非侵入性机械通风 (IMV和NIV) 的使用在在医院死亡的儿童中增加. IMV和NIV的组合与更高的资源使用有关,这表明需要仔细考虑通风策略.
科学领域:
- 儿科重症监护医药 儿科重症监护医药
- 医疗服务研究 医疗服务研究
- 呼吸系统疗法 呼吸系统疗法
背景情况:
- 机械通风是重症儿童的关键干预措施.
- 了解通风使用和资源利用的趋势对于优化护理至关重要.
研究的目的:
- 确定在医院死亡的儿童中侵入性机械呼吸 (IMV) 和非侵入性机械呼吸 (NIV) 的患病率和趋势.
- 评估通风模式与医院资源利用之间的关系.
主要方法:
- 一项回顾性队列研究,对37家美国儿童医院 (2010-2019) 的41091例住院治疗情况进行了回顾性研究.
- 分析包括单变量和多变量后勤回归来检查通风使用和资源利用.
- 统计测试包括 χ2,克鲁斯卡尔-瓦利斯和多变量回归模型.
主要成果:
- 虽然IMV使用保持稳定 (∼88.5%),但NIV使用增加 (18.8%至25.9%),IMV + NIV联合使用显著增加 (16.8%至22.8%).
- 单独使用NIV与ICU入院和死亡的几率较低,ICU停留时间较短 (LOS) 和成本较低相比仅使用IMV有关.
- 联合IMV + NIV与更高的ICU入院率,更长的IMV持续时间,更长的ICU和医院LOS以及成本增加有关.
结论:
- 在死亡的儿童中,NIV的使用增加了,但IMV没有减少,这导致了IMV + NIV组合的更多使用.
- IMV + NIV的组合与显著更高的医院资源利用率有关.
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