背景:拔管失败风险高的婴儿通常采用无创通气(NIV)或CPAP治疗,但是关于这些支持方式在拔管后的作用的数据很少.本报告描述了我们在儿科ICU(PICU)中使用NIV或CPAP支持拔管后的婴儿的经验。
方法:我们对10公斤以下的儿童进行了回顾性研究,在我们的PICU中接受拔管后NIV或CPAP。人口统计数据,病史,支持类型,生命体征,脉搏血氧饱和度,近红外光谱(NIRS),气体交换,支持设置,并从电子病历中提取重新插管。如果计划在拔管前进行支持,则将其归类为预防性支持,如果在拔管后24小时内开始进行抢救。我们使用分类变量的卡方检验和连续变量的Mann-Whitney检验比较了成功的拔管和重新插管的受试者。
结果:我们研究了51个受试者,中位年龄44(四分位距0.5-242)d,体重3.7(3-4.9)kg。组间没有人口统计学差异,除了那些重新插管的人更有可能在入院前接受过心脏手术(0%vs14%,P=.040)。31例(61%)使用NIV,20例(39%)使用CPAP。在25名受试者(49%)中启动了预防性支持,而26名受试者(51%)需要救援支持.22名受试者(43%)需要重新插管。抢救支持的再插管率较高(58%vs28%,P=.032)。pH<7.35的受试者(4.3%vs42.0%,P=.003)和较低的体细胞NIRS(39[24-56]对62[46-72],P=.02)更有可能重新插管。吸气气道正压,呼气气道正压,需要重新插管的受试者的FIO2较高。
结论:在异质高危婴儿样本中,使用NIV或CPAP与43%的再插管率相关。酸中毒,心脏手术,较高的FIO2,较低的体细胞NIRS,更高的支持设置,抢救支持的应用与重新插管的需要相关.
BACKGROUND: Infants with a high risk of extubation failure are often treated with noninvasive ventilation (NIV) or CPAP, but data on the role of these support modalities following extubation are sparse. This report describes our experience using NIV or CPAP to support infants following extubation in our pediatric ICUs (PICUs).
METHODS: We performed a retrospective study of children < 10 kg receiving postextubation NIV or CPAP in our PICUs. Data on demographics, medical history, type of support, vital signs, pulse oximetry, near-infrared spectroscopy (NIRS), gas exchange, support settings, and re-intubation were extracted from the electronic medical record. Support was classified as prophylactic if planned before extubation and rescue if initiated within 24 h of extubation. We compared successfully extubated and re-intubated subjects using chi-square test for categorical variables and Mann-Whitney test for continuous variables.
RESULTS: We studied 51 subjects, median age 44 (interquartile range 0.5-242) d and weight 3.7 (3-4.9) kg. There were no demographic differences between groups, except those re-intubated were more likely to have had cardiac surgery prior to admission (0% vs 14%, P = .040). NIV was used in 31 (61%) and CPAP in 20 (39%) subjects. Prophylactic support was initiated in 25 subjects (49%), whereas rescue support was needed in 26 subjects (51%). Twenty-two subjects (43%) required re-intubation. Re-intubation rate was higher for rescue support (58% vs 28%, P = .032). Subjects with a pH < 7.35 (4.3% vs 42.0%, P = .003) and lower somatic NIRS (39 [24-56] vs 62 [46-72], P = .02) were more likely to be re-intubated. The inspiratory positive airway pressure, expiratory positive airway pressure, and FIO2 were higher in subjects who required re-intubation.
CONCLUSIONS: NIV or CPAP use was associated with a re-intubation rate of 43% in a heterogeneous sample of high-risk infants. Acidosis, cardiac surgery, higher FIO2 , lower somatic NIRS, higher support settings, and application of rescue support were associated with the need for re-intubation.