目的:确定与儿科重症监护病房(PICU)中儿科患者长时间机械通气(pMV)相关的因素。
方法:前瞻性队列的二次分析。
方法:在2017年4月至2022年1月期间,作为LARedNetwork一部分的中心的PICU。
方法:儿科患者因呼吸道原因进行机械通气(IMV)。我们定义的IMV时间大于全球队列的第75百分位数。
方法:无。
方法:人口统计数据,诊断,严重性评分,疗法,并发症,逗留时间,发病率,和死亡率。
结果:纳入1698名MV为8±7天的儿童,pIMV定义为9天。入院相关因素为6月龄以下(OR1.61,95%CI1.17-2.22),支气管肺发育不良(OR3.71,95%CI1.87-7.36),和真菌感染(OR6.66,95%CI1.87-23.74),而哮喘患者的pIMV风险较低(OR0.30,95%CI0.12-0.78).关于在PICU的进展和停留时间,它与通气相关肺炎有关(OR4.27,95%CI1.79-10.20),需要气管造口术(OR2.91,95%CI1.89-4.48),输血(OR2.94,95%CI2.18-3.96),神经肌肉阻滞(OR2.08,95%CI1.48-2.93),高频通气(OR2.91,95%CI1.89-4.48),和PICU停留时间更长(OR1.13,95%CI1.10-1.16)。此外,平均气道压大于13cmH2O与pIMV相关(OR1.57,95%CI1.12-2.21).
结论:在PICUs的儿科患者中,与IMV持续时间大于9天相关的因素在入院方面被确定,进化,和逗留时间的长短。
To identify factors associated with prolonged mechanical ventilation (pMV) in pediatric patients in pediatric intensive care units (PICUs).
Secondary analysis of a prospective cohort.
PICUs in centers that are part of the LARed Network between April 2017 and January 2022.
Pediatric patients on mechanical ventilation (IMV) due to respiratory causes. We defined IMV time greater than the 75th percentile of the global cohort.
None.
Demographic data, diagnoses, severity scores, therapies, complications, length of stay, morbidity, and mortality.
1698 children with MV of 8±7 days were included, and pIMV was defined as 9 days. Factors related to admission were age under 6 months (OR 1.61, 95% CI 1.17-2.22), bronchopulmonary dysplasia (OR 3.71, 95% CI 1.87-7.36), and fungal infections (OR 6.66, 95% CI 1.87-23.74), while patients with asthma had a lower risk of pIMV (OR 0.30, 95% CI 0.12-0.78). Regarding evolution and length of stay in the PICU, it was related to ventilation-associated pneumonia (OR 4.27, 95% CI 1.79-10.20), need for tracheostomy (OR 2.91, 95% CI 1.89-4.48), transfusions (OR 2.94, 95% CI 2.18-3.96), neuromuscular blockade (OR 2.08, 95% CI 1.48-2.93), high-frequency ventilation (OR 2.91, 95% CI 1.89-4.48), and longer PICU stay (OR 1.13, 95% CI 1.10-1.16). In addition, mean airway pressure greater than 13cmH2O was associated with pIMV (OR 1.57, 95% CI 1.12-2.21).
Factors related to IMV duration greater than 9 days in pediatric patients in PICUs were identified in terms of admission, evolution, and length of stay.