目的:儿科重症监护病房(PICU)收治的重症急性细支气管炎患儿的治疗可能与一般建议不同。我们研究的第一个目的是描述在西班牙三级PICU中为这些儿童提供的治疗方法。第二个目标是分析2014年美国儿科学会(AAP)细支气管炎指南发布后的管理变化。
方法:这是一项在两次流行浪潮(2014-2015年和2015-2016年)期间进行的回顾性前瞻性观察研究。在两次流行浪潮之间,AAP指南已分发并教授给PICU工作人员。
结果:共纳入138名儿童(78名男性)。在第一阶段,78名儿童入学。中位年龄为1.8个月(IQR1.1-3.6)。在这两个时期的管理之间没有差异,除了使用高流量氧疗(HFOT);其使用在第二阶段增加。总的来说,83%的患者接受了无创通气或HFOT。12个月以上的儿童仅接受HFOT。相比之下,在2015-2016年期间,持续气道正压和双水平气道正压使用较少(P=0.036).关于药物治疗,70%的患者接受了抗生素治疗,23%的类固醇,33%沙丁胺醇,31%的肾上腺素,和7%的高渗盐水。死亡率为零。
结论:我们的PICU没有遵循AAP的建议。这两个时期没有区别,除了使用HFOT。所有12个月以上的儿童仅接受HFOT。有创机械通气的使用率也很低。
OBJECTIVE: The treatment applied for children admitted to the pediatric intensive care unit (PICU) for severe acute bronchiolitis may differ from general recommendations. The first objective of our study was to describe the treatments offered to these children in a Spanish tertiary PICU. The second objective was to analyse the changes in management derived from the publication of the American Academy of Pediatrics (AAP) bronchiolitis
guideline in 2014.
METHODS: This was a retrospective-prospective observational study conducted during two epidemic waves (2014-2015 and 2015-2016). The AAP
guidelines were distributed and taught to PICU staff between both epidemic waves.
RESULTS: A total of 138 children were enrolled (78 male). In the first period, 78 children were enrolled. The median age was 1.8 months (IQR 1.1-3.6). There were no differences between the management in the two periods, except for the use of high-flow oxygen therapy (HFOT); its use increased in the second period. Overall, 83% of patients received non-invasive ventilation or HFOT. Children older than 12 months received HFOT exclusively. In comparison, continuous positive airway pressure and bi-level positive airway pressure were used less during the period 2015-2016 (P=0.036). Regarding pharmacological therapy, 70% of patients received antibiotics, 23% steroids, 33% salbutamol, 31% adrenaline, and 7% hypertonic saline. The mortality rate was zero.
CONCLUSIONS: Our PICU did not follow the AAP recommendations. There were no differences between the two periods, except in the use of HFOT. All children older than 12 months received HFOT exclusively. The rate of using invasive mechanical ventilation was also low.