在经历脊柱融合的医疗复杂性儿童的术后机械通风:儿科健康信息系统数据库,2016-2021年队列
Jennifer M Perez1,2, Matt Hall3, Robert J Graham1,2
1Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA.
大约13%的患有医疗复杂性的儿童在脊髓融合后需要长时间的侵入性机械通风 (IMV). 潜在的慢性疾病显著影响了IMV的持续时间,突出了潜在的护理改进领域.
科学领域:
- 儿科重症监护医药 儿科重症监护医药
- 脊柱手术的结果 脊柱手术的结果
- 医学复杂性研究研究医学复杂性研究
背景情况:
- 患有医疗复杂性的儿童在进行重大手术后往往需要长时间的重症监护室 (ICU) 住院.
- 侵入性机械通风 (IMV) 持续时间是术后恢复和资源利用的关键指标.
- 在这群经历脊髓融合的患者中,影响IMV持续时间的因素尚未完全理解.
研究的目的:
- 为了确定长期手术后IMV的患病率在经历脊柱融合的医疗复杂性的儿童.
- 确定与IMV持续时间相关的患者特异性和全身性因素.
- 探索脊柱融合后IMV利用的区域差异.
主要方法:
- 使用儿科健康信息系统数据库进行回顾性队列研究.
- 纳入标准:年龄在5至18岁之间,患有潜在神经肌肉或遗传疾病的患者,接受胸椎腰椎脊柱融合治疗.
- 收集了47家美国儿童医院的人口统计,并发病症和术后通风持续时间的数据.
主要成果:
- 在6511名符合条件的患者中,6.7%的患者有先前存在的气管切除术和呼吸机依赖.
- 5.7%和7%的患者需要IMV分别为4-6天和>=7天.
- 神经,呼吸道,皮肤,血液,内分泌,尿器生殖和心脏疾病与长期IMV (>=4天) 的几率增加有关. 手术前的气管切除术与较低的几率有关.
结论:
- 大约八分之一的患有医疗复杂性的儿童需要超过4天的IMV后脊髓融合.
- 各种器官系统的多种慢性疾病与长期的IMV有关.
- 需要对慢性疾病,临床因素和区域变异进行进一步的研究,以优化护理并减少IMV持续时间.
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