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断奶失败:预测因素和与儿科后试管无创性呼吸支持相关的不良结果
Samer Abu-Sultaneh1, Colin M Rogerson2, Jeremy M Loberger3
1Division of Pediatric Critical Care Medicine, Department of Pediatrics, Riley Hospital for Children at Indiana University Health and Indiana University School of Medicine, Indianapolis, IN.
The Journal of pediatrics
|December 11, 2025
概括
术后非侵入性呼吸支 (NRS) 是常见的,通常用作救援疗法. 如果在48小时内没有从NRS中释放出来,就会导致患者的治疗结果较差,这凸显了对优化策略的需求.
科学领域:
- 儿科重症监护医学 儿科重症监护医学
- 呼吸系统疗法 呼吸系统疗法
- 提高医疗保健的质量 改善医疗保健的质量
背景情况:
- 非侵入性呼吸辅助 (NRS) 在儿科患者的输出管术后经常使用.
- 使用模式和影响 postextubation NRS 的因素仍然不完全理解.
- 与NRS策略相关的以患者为中心的结果需要进一步调查.
研究的目的:
- 描述在儿科患者中使用脱后NRS的特点.
- 确定与未能在48小时内从NRS中解脱相关的临床变量和机构因素.
- 探索术后NRS使用与患者结局之间的关系.
主要方法:
- 对儿童患者 (≤18岁) 进行回顾性队列研究,需要侵入性机械通风 (IMV) ≥24小时.
- 数据来源于虚拟儿科系统多中心质量改进数据库 (2013-2022年).
- 主要结局:未能从NRS中释放≤48小时的 postextubation;二次结局使用混合效应逻辑回归分析.
主要成果:
- 高流量鼻腔管是最常用的NRS,救援部署的频率高于计划.
- 与未能从NRS ≤48小时释放出来相关的因素包括年龄较大,研究年龄较晚,高风险诊断,使用双级正气道压力 (BiPAP) 或连续正气道压力 (CPAP),以及长时间的IMV持续时间 (≥7天).
- 无法从NRS中释放与更长的NRS持续时间,延长ICU/住院时间和增加死亡率相关.
结论:
- 术后的NRS被广泛使用,主要是作为救援干预.
- 如果在48小时内没有从NRS中释放,则与患者的不良结果有关.
- 优化NRS部署和定位对于改善患者结果至关重要,并保证进一步的研究和质量改进举措.
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