Abstract：
Hypoxemia is used to stratify severity in acute respiratory failure (ARF) but is less useful in cyanotic congenital heart disease (CCHD) due to an inability to differentiate hypoxemia from lung injury versus cardiac shunting. Therefore, we aimed to determine whether variables related to respiratory mechanics were associated with outcomes to assist in stratifying ARF severity in pediatric CCHD. We performed a retrospective cohort study from a single cardiac intensive care unit enrolling children with CCHD with ARF requiring mechanical ventilation between 2011 and 2019. Time-averaged ventilator settings and oxygenation data in the first 24 h of ARF were screened for association with the primary outcome of 28-day mortality. Of 344 eligible patients, peak inspiratory pressure (PIP) and driving pressure (ΔP) were selected as candidate variables to stratify ARF severity. PIP (OR 1.10, 95% CI 1.02-1.19) and ΔP (1.11, 95% CI 1.01-1.24) were associated with higher mortality and fewer ventilator-free days (VFDs) at 28 days after adjusting for age, severity of cardiac history, and FiO2. A three-level (mild, moderate, severe) severity stratification was established for both PIP (≤ 20, 21-29, ≥ 30) and ΔP (≤ 16, 17-24, ≥ 25), showing increasing mortality (both P < 0.01), decreasing VFDs and increasing ventilator days in survivors (all P < 0.05) across increasing pressures. Overall, we found that higher PIP and ΔP were associated with mortality and duration of ventilation across a three-level severity stratification system in pediatric CCHD with ARF, providing a practical method to prognosticate in subjects with multifactorial etiologies for hypoxemia.
摘要：
低氧血症用于对急性呼吸衰竭（ARF）的严重程度进行分层，但由于无法将低氧血症与肺损伤和心脏分流区分开来，因此在紫红色先天性心脏病（CCHD）中的应用较少。因此,我们旨在确定与呼吸力学相关的变量是否与结局相关,以帮助对小儿CCHD的ARF严重程度进行分层.我们进行了一项回顾性队列研究，该研究来自2011年至2019年之间招募需要机械通气的CCHD合并ARF儿童的单个心脏重症监护病房。在ARF的前24小时，平均呼吸机设置和氧合数据被筛选为与28天死亡率的主要结果的关联。在344名符合条件的患者中，选择峰值吸气压力（PIP）和驱动压力（ΔP）作为候选变量，以对ARF严重程度进行分层。PIP（OR1.10，95％CI1.02-1.19）和ΔP（1.11，95％CI1.01-1.24）与调整年龄后28天的较高死亡率和较少的无呼吸机天数（VFD）相关，心脏病史的严重程度，FiO2三级(轻度，中度,严重)对PIP(≤20、21-29、≥30)和ΔP(≤16、17-24、≥25)都建立了严重程度分层，显示死亡率增加（均P<0.01），随着压力的增加，幸存者的VFD减少和呼吸机天数增加（所有P<0.05）。总的来说,我们发现，较高的PIP和ΔP与小儿CCHD合并ARF的三级严重程度分层系统中的死亡率和通气持续时间相关。提供了一种实用的方法来预测低氧血症的多因素病因。
