小儿急性呼吸窘迫综合征(PARDS)是一个具有高死亡率的挑战性问题。迄今为止,神经肌肉阻滞在ARDS管理中的作用一直存在争议,这项研究是为了研究神经肌肉阻滞在患有PARDS和相关并发症的儿童中的作用,如果有的话。这是一个潜在的,在三级护理教学医院的儿科重症监护病房(PICU)进行的病例对照研究,为期24个月。在获得父母和/或监护人的书面知情同意后,纳入住院期间出现或发展为PARDS的1至18岁患者。将需要有创机械通气的PARDS患者分为病例组和对照组。病例组患者使用咪达唑仑(1µg/kg/min)和维库溴铵(1µg/kg/min)镇静和瘫痪,分别,以及明确的管理机构。对照组患者给予确定性和支持性治疗,但没有神经肌肉阻断剂(NMBAs)。所有患者均在整个住院期间和出院后3个月内随访肌病或神经病的体征和症状。在学习期间,613例患者进入PICU,其中91例患者符合PARDS的诊断标准。在91例PARDS患者中,有67例(73.6%)以脓毒症为主要病因。59名患者被纳入研究,其中29例患者纳入病例组,30例患者纳入对照组。在29例患者中,25例(86.2%)成功拔管。病例组4名患者过期,而30名对照组患者中有14名(46.7%)过期。有26例患者出现低血压(89.6%),其中所有在明确治疗后48小时内显示出消退。病例组患者低血压消退的平均时间为41.6小时(标准差[SD]:5.759;范围:24-48),显著低于(p<0.0001)10例存活的低血压对照组患者的平均消退时间103小时(SD:18.995;范围:90-126)。维库溴铵治疗48小时后的平均氧合指数(OI)显着低于病例组患者入院时的平均OI(p<0.0001;95%置信区间:5.9129-9.9671)。接受维库溴铵治疗的患者在住院期间均未出现神经肌肉缺损,在出院时,或在出院后3个月的随访评估。在这项研究中,诊断为PARDS并接受机械通气和维库溴铵治疗的儿科病例在NMBA治疗48小时后平均OI改善,死亡率低于对照组.在这些患者中,NMBA相关弱点的发生率并不常见。
Pediatric acute respiratory distress syndrome (
PARDS) is a challenging problem with high mortality. Role of neuromuscular blockade in the management of ARDS to date has been controversial, and this study was done to study the role of neuromuscular blockade in children having
PARDS and development of associated complications, if any. This was a prospective, case-control study conducted in the pediatric intensive care unit (PICU) of a tertiary care teaching hospital, over a period of 24 months. Patients of age 1 to 18 years who presented with or developed
PARDS during their course of hospitalization were included after written informed consent was obtained from their parents and/or guardians. Patients with
PARDS requiring invasive mechanical ventilation were partitioned into a case group and a control group. Case group patients were sedated and paralyzed using midazolam (1 µg/kg/min) and vecuronium (1 µg/kg/min), respectively, along with institution of definitive management. Control group patients were given definitive and supportive therapy, but no neuromuscular blocking agents (NMBAs). All patients were followed up for signs and symptoms of myopathy or neuropathy during the entire duration of hospital stay and up to 3 months after discharge. During the study period, 613 patients were admitted to the PICU of which 91 patients qualified as having PARDS. Sepsis was the main etiology in 67 of the 91 patients (73.6%) with
PARDS. Fifty-nine patients were included in the study, of which 29 patients were included in the case group and 30 patients were included in the control group. Among the 29 case group patients, 25 patients (86.2%) were successfully extubated. Four patients from the case group expired, while 14 out of 30 control group patients (46.7%) expired. Hypotension was present in 26 case group patients (89.6%), of which all showed resolution within 48 hours of definitive treatment. The mean time to resolution of hypotension was 41.6 hours (standard deviation [SD]: 5.759; range: 24-48) for case group patients, significantly lower ( p < 0.0001) than the mean time to resolution of 103 hours (SD: 18.995; range: 90-126) for the 10 control group patients with hypotension that survived. Mean oxygenation index (OI) following 48 hours of vecuronium therapy was significantly lower ( p < 0.0001; 95% confidence interval: 5.9129-9.9671) than mean OI at admission for case group patients. None of the patients receiving vecuronium exhibited neuromuscular deficit during their hospital stay, at time of discharge, or at follow-up evaluation up to 3 months after discharge. In this study, pediatric cases diagnosed with PARDS and managed with mechanical ventilation and vecuronium therapy had improved mean OI following 48 hours of NMBA therapy and a lower mortality when compared with matched control group patients. Incidence of NMBA-related weakness was not commonly observed in these patients.