背景:婴儿呼吸衰竭是进入儿科ICU(PICU)的常见原因。尽管高流量鼻插管(HFNC)是我们机构首选的一线治疗方法,一些婴儿需要CPAP或非侵入性通气(NIV)。在这里,我们报告了我们在<10kg的婴儿中使用CPAP/NIV的经验。
方法:我们对2017年7月至2021年5月在我们的PICUs中接受CPAP/NIV治疗的<10kg的婴儿进行了回顾性研究。人口统计,支持类型和设置,生命体征,脉搏血氧饱和度,并从电子健康记录中提取插管数据。我们将成功接受CPAP/NIV治疗的受试者与需要插管的受试者进行了比较。
结果:我们研究了62名受试者,中位年龄(四分位距)96[6.5-308]d,体重4.5(3.4-6.6)kg。其中,22(35%)需插管。人口统计学没有显著差异,病史,主接口,预CPAP/NIV支持,和用于提供CPAP/NIV的装置。在升级到CPAP/NIV之前,57名(92%)受试者使用了HFNC。CPAP/NIV失败的受试者患毛细支气管炎的可能性较小(27%vs60%,P=.040),从医院出院回家的可能性较小(68%对93%,P=.02),住院时间中位数(LOS)较长(26.9[21-50.5]dvs10.4[5.6-28.4]d,P=.002),ICULOS中位数(14.6[7.9-25.2]dvs5.8[3.8-12.4]d,P=.004)。最初的生命体征和FIO2相似,但对于CPAP/NIV失败的受试者,在支持开始后6小时和12小时,SpO2较低,FIO2较高。最初的CPAP/NIV设置相似,但是CPAP/NIV失败的受试者的最大和最终吸气/呼气压更高。
结论:大多数最初的HFNC支持失败的婴儿在没有插管的情况下使用NIV或CPAP治疗成功。毛细支气管炎与CPAP/NIV失败率较低相关,而较低的SpO2和较高的FIO2水平与较高的插管率相关。
BACKGROUND: Respiratory failure in infants is a common reason for admission to the pediatric ICU (PICU). Although high-flow nasal cannula (HFNC) is the preferred first-line treatment at our institution, some infants require CPAP or noninvasive ventilation (NIV). Here we report our experience using
CPAP/NIV in infants < 10 kg.
METHODS: We conducted a retrospective review of infants < 10 kg treated with CPAP/NIV in our PICUs between July 2017-May 2021 in the initial phase of treatment. Demographic, support type and settings, vital signs, pulse oximetry, and intubation data were extracted from the electronic health record. We compared subjects successfully treated with
CPAP/NIV with those who required intubation.
RESULTS: We studied 62 subjects with median (interquartile range) age 96 [6.5-308] d and weight 4.5 (3.4-6.6) kg. Of these, 22 (35%) required intubation. There were no significant differences in demographics, medical history, primary interface, pre-CPAP/NIV support, and device used to deliver
CPAP/NIV. HFNC was used in 57 (92%) subjects before escalation to
CPAP/NIV. Subjects who failed CPAP/NIV were less likely to have bronchiolitis (27% vs 60%, P = .040), less likely to be discharged from the hospital to home (68% vs 93%, P = .02), had a longer median hospital length of stay (LOS) (26.9 [21-50.5] d vs 10.4 [5.6-28.4] d, P = .002), and longer median ICU LOS (14.6 [7.9-25.2] d vs 5.8 [3.8-12.4] d, P = .004). Initial vital signs and FIO2 were similar, but SpO2 was lower and FIO2 higher at 6 h and 12 h after support initiation for subjects who failed CPAP/NIV. Initial
CPAP/NIV settings were similar, but subjects who failed
CPAP/NIV had higher maximum and final inspiratory/expiratory pressure.
CONCLUSIONS: Most infants who failed initial HFNC support were successfully managed without intubation using NIV or CPAP. Bronchiolitis was associated with a lower rate of CPAP/NIV failure, whereas lower SpO2 and higher FIO2 levels were associated with higher rates of intubation.