需要通过气管切除术进行长期机械通风的儿童的再入院和死亡率:系统性审查
Lindsey Scheller1, Karley Mariano2, Sandra Staveski2
1School of Nursing, University of California San Francisco, 490 Illinois St., San Francisco, CA, 94143, USA. Lindsey.Scheller@ucsf.edu.
BMC pulmonary medicine
|August 12, 2025
概括
通过气管切除术 (LTMV-T) 进行长期机械通风的儿童经常经历再入院和死亡,特别是在出院后的两年内. 临床和人口因素是关键风险指标,需要有针对性的干预措施.
科学领域:
- 儿科重症监护医药 儿科重症监护医药
- 呼吸系统药物 呼吸系统药物
- 医疗服务研究 医疗服务研究
背景情况:
- 家庭环境提高了生活质量,并减少了通过气管切除术 (LTMV-T) 进行长期机械通风的儿童的感染.
- 意想不到的医院再入院和死亡率仍然是这个脆弱人群的重大担忧.
- 现有的系统性审查还没有全面检查儿科LTMV-T患者再入院和死亡率的风险因素.
研究的目的:
- 系统地审查和检查可修改和不可修改的风险因素,与LTMV-T的儿科患者的再入院和死亡率相关.
- 确定可以为风险评估提供信息的关键因素,并指导针对性的干预措施,以改善需要LTMV-T的儿童的结果.
- 突出当前研究中的差距,特别是关于社会环境风险因素的差距.
主要方法:
- 从创立到2024年,对五个数据库 (PubMed,CINAHL,Web of Science,Embase,Epistemonikos) 进行了全面的系统搜索.
- 包括所有检查21岁以下儿童LTMV-T再入院和/或死亡风险因素的定量研究设计,仅限于同行评审的英语文章.
- 数据管理,选,提取和偏差风险评估使用Covidence和Joanna Briggs研究所工具进行,双审核员独立审查.
主要成果:
- 分析了26项研究 (1980-2023年),涉及27至8009名接受LTMV-T的儿童.
- 超过50%的再入院发生在出院后的两年内,呼吸系统问题占30-75%;第一年死亡率从0%到16%不等.
- 确定的风险因素包括年龄,收入较低,出院倾向,并发症,缺乏呼吸器理疗,胃口管和出生体重较低;偏差风险低至中等.
结论:
- 儿科LTMV-T患者的再入院频繁,具有相当大的死亡风险,特别是在前两年内.
- 主要的风险因素是临床和人口,为改善风险分层和干预策略提供了基础.
- 建议进行进一步的研究,以探索LTMV-T特定人群中的社会环境因素,包括健康的社会决定因素.
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