PDF(Pubmed)
Abstract：
BACKGROUND: Postextubation respiratory support in pediatric ARDS may be used to support the recovering respiratory system and promote timely, successful liberation from mechanical ventilation. This study\'s aims were to (1) describe the use of postextubation respiratory support in pediatric ARDS from the time of extubation to hospital discharge, (2) identify potential risk factors for postextubation respiratory support, and (3) provide preliminary data for future larger studies.
METHODS: This pilot single-center prospective cohort study recruited subjects with pediatric ARDS. Subjects\' respiratory status up to hospital discharge, the use of postextubation respiratory support, and how it changed over time were recorded. Analysis was performed comparing subjects who received postextubation respiratory support versus those who did not and compared its use among pediatric ARDS severity categories. Multivariable logistic regression was used to determine variables associated with the use of postextubation respiratory support and included oxygenation index (OI), ventilator duration, and weight.
RESULTS: Seventy-three subjects with pediatric ARDS, with median age and OI of 4 (0.6-10.5) y and 7.3 (4.9-12.7), respectively, were analyzed. Postextubation respiratory support was provided to 54/73 (74%) subjects: 28/45 (62.2%), 19/21 (90.5%), and 7/7 (100%) for mild, moderate, and severe pediatric ARDS, respectively, (P = .01). OI and mechanical ventilation duration were higher in subjects who received postextubation respiratory support (8.7 [5.4-14] vs 4.6 [3.7-7], P < .001 and 10 [7-17] d vs 4 [2-7] d, P < .001) compared to those who did not. At hospital discharge, 12/67 (18.2%) survivors received home respiratory support (6 subjects died prior to hospital discharge). In the multivariable model, ventilator duration (adjusted odds ratio 1.3 [95% CI 1.0-1.7], P = .050) and weight (adjusted odds ratio 0.95 [95% CI 0.91-0.99], P = .02) were associated with the use of postextubation respiratory support.
CONCLUSIONS: The majority of intubated subjects with pediatric ARDS received respiratory support postextubation, and a substantial proportion continued to require it up to hospital discharge.
METHODS: This pilot single-center prospective cohort study recruited subjects with pediatric ARDS. Subjects\' respiratory status up to hospital discharge, the use of postextubation respiratory support, and how it changed over time were recorded. Analysis was performed comparing subjects who received postextubation respiratory support versus those who did not and compared its use among pediatric ARDS severity categories. Multivariable logistic regression was used to determine variables associated with the use of postextubation respiratory support and included oxygenation index (OI), ventilator duration, and weight.
RESULTS: Seventy-three subjects with pediatric ARDS, with median age and OI of 4 (0.6-10.5) y and 7.3 (4.9-12.7), respectively, were analyzed. Postextubation respiratory support was provided to 54/73 (74%) subjects: 28/45 (62.2%), 19/21 (90.5%), and 7/7 (100%) for mild, moderate, and severe pediatric ARDS, respectively, (P = .01). OI and mechanical ventilation duration were higher in subjects who received postextubation respiratory support (8.7 [5.4-14] vs 4.6 [3.7-7], P < .001 and 10 [7-17] d vs 4 [2-7] d, P < .001) compared to those who did not. At hospital discharge, 12/67 (18.2%) survivors received home respiratory support (6 subjects died prior to hospital discharge). In the multivariable model, ventilator duration (adjusted odds ratio 1.3 [95% CI 1.0-1.7], P = .050) and weight (adjusted odds ratio 0.95 [95% CI 0.91-0.99], P = .02) were associated with the use of postextubation respiratory support.
CONCLUSIONS: The majority of intubated subjects with pediatric ARDS received respiratory support postextubation, and a substantial proportion continued to require it up to hospital discharge.
摘要：
背景：小儿ARDS的拔管后呼吸支持可用于支持呼吸系统的恢复和及时促进，成功地从机械通气中解放出来。本研究的目的是（1）描述使用拔管后呼吸支持在小儿ARDS从拔管时间到出院，(2)确定拔管后呼吸支持的潜在危险因素,(3)为未来更大的研究提供初步数据。
方法：这项试点单中心前瞻性队列研究招募了患有小儿ARDS的受试者。受试者的呼吸状态直至出院，使用拔管后呼吸支持，记录了它随着时间的变化。对接受拔管后呼吸支持的受试者与未接受拔管后呼吸支持的受试者进行了比较分析，并在小儿ARDS严重程度类别中比较了其使用情况。多变量逻辑回归用于确定与使用拔管后呼吸支持相关的变量，并包括氧合指数（OI）。呼吸机持续时间,和重量。
结果：73名儿科ARDS患者，中位年龄和OI为4(0.6-10.5)y和7.3(4.9-12.7)，分别,进行了分析。向54/73（74%）受试者提供拔管后呼吸支持：28/45（62.2%），19/21（90.5%），和7/7（100％）为轻度，中度,和严重的儿科ARDS，分别,（P=0.01）。接受拔管后呼吸支持的受试者的OI和机械通气持续时间较高（8.7[5.4-14]vs4.6[3.7-7]，P<.001和10[7-17]dvs4[2-7]d，P<.001）与没有的人相比。出院时，12/67（18.2%）幸存者接受家庭呼吸支持（6名受试者在出院前死亡）。在多变量模型中，呼吸机持续时间(调整后比值比1.3[95%CI1.0-1.7]，P=.050)和体重(调整后的赔率比0.95[95%CI0.91-0.99]，P=.02）与拔管后呼吸支持的使用有关。
结论：大多数患有小儿ARDS的插管受试者在拔管后接受了呼吸支持，很大一部分人继续需要它直到出院。
方法：这项试点单中心前瞻性队列研究招募了患有小儿ARDS的受试者。受试者的呼吸状态直至出院，使用拔管后呼吸支持，记录了它随着时间的变化。对接受拔管后呼吸支持的受试者与未接受拔管后呼吸支持的受试者进行了比较分析，并在小儿ARDS严重程度类别中比较了其使用情况。多变量逻辑回归用于确定与使用拔管后呼吸支持相关的变量，并包括氧合指数（OI）。呼吸机持续时间,和重量。
结果：73名儿科ARDS患者，中位年龄和OI为4(0.6-10.5)y和7.3(4.9-12.7)，分别,进行了分析。向54/73（74%）受试者提供拔管后呼吸支持：28/45（62.2%），19/21（90.5%），和7/7（100％）为轻度，中度,和严重的儿科ARDS，分别,（P=0.01）。接受拔管后呼吸支持的受试者的OI和机械通气持续时间较高（8.7[5.4-14]vs4.6[3.7-7]，P<.001和10[7-17]dvs4[2-7]d，P<.001）与没有的人相比。出院时，12/67（18.2%）幸存者接受家庭呼吸支持（6名受试者在出院前死亡）。在多变量模型中，呼吸机持续时间(调整后比值比1.3[95%CI1.0-1.7]，P=.050)和体重(调整后的赔率比0.95[95%CI0.91-0.99]，P=.02）与拔管后呼吸支持的使用有关。
结论：大多数患有小儿ARDS的插管受试者在拔管后接受了呼吸支持，很大一部分人继续需要它直到出院。
