背景:我们旨在描述我们在体外膜氧合(ECMO)支持下对儿童进行支气管镜检查以诊断和缓解气管支气管阻塞的经验。
方法:对2018年1月至2022年12月接受ECMO的儿童进行回顾性队列研究。
结果:在心脏研究期间,共有107名儿童需要ECMO支持(n=48,45%),肺(n=38,36%),或心肺功能障碍(n=21,20%)。37例(35%)患者在接受ECMO时接受了99次支气管镜检查。大多数(76%,n=75)在支气管镜检查后24小时,胸部X线检查没有改善或恶化。在有可用数据的13/25患者中,首次支气管镜检查后48小时潮气量的临床改善(p=0.05)。不良事件见于18例(49%)接受支气管镜检查的患者,包括气胸(n=8,22%),肺炎(n=7,19%),肺出血(n=6,16%),和脓毒症(n=5,14%)。ECMO课程更长(25.4±37.2vs6.1±8.8天,p<0.0001),并且与未接受支气管镜检查的患者相比,接受支气管镜检查的患者更容易并发肺炎(p=0.0004)和败血症(p=0.047)。支气管镜检查后的不良事件与支气管镜检查次数(p=0.0003)和阻塞性物质的存在有关,但与支气管镜检查的类型或ECMO适应症无关。接受支气管镜检查的患者和未接受支气管镜检查的患者的死亡率相似。
结论:需要支气管镜检查的儿童代表ECMO病重儿童的一部分。支气管镜检查可能为无法进行拔管的持续性心肺功能衰竭儿童提供益处。不良事件与支气管镜检查次数和阻塞性物质的存在有关。
方法:4喉镜,2024.
BACKGROUND: We aim to describe our experience with bronchoscopy to diagnose and relieve tracheobronchial obstruction in anticipation of decannulation in children on extracorporeal membrane oxygenation (ECMO) support.
METHODS: A retrospective cohort study of children on ECMO between 1/2018 and 12/2022.
RESULTS: A total of 107 children required ECMO support during the study period for cardiac (n = 48, 45%), pulmonary (n = 38, 36%), or cardiopulmonary dysfunction (n = 21, 20%). Thirty-seven (35%) patients underwent 99 bronchoscopies while on ECMO. Most (76%, n = 75) experienced no improvement or worsening of chest radiography 24 hours following bronchoscopy. Clinical improvement in tidal volumes 48 hours after the first bronchoscopy was noted in 13/25 patients with available data (p = 0.05). Adverse events were seen in 18 (49%) patients who underwent bronchoscopy, including pneumothorax (n = 8, 22%), pneumonia (n = 7, 19%), pulmonary hemorrhage (n = 6, 16%), and sepsis (n = 5, 14%). ECMO courses were longer (25.4 ± 37.2 vs 6.1 ± 8.8 days, p < 0.0001) and more likely to be complicated by pneumonia (p = 0.0004) and sepsis (p = 0.047) in patients who underwent bronchoscopy compared with those who did not. Adverse events following bronchoscopy were associated with the number of bronchoscopies (p = 0.0003) and the presence of obstructive materials but not with the type of bronchoscopy or indication for ECMO. Mortality rates were similar between patients who underwent bronchoscopy and those who did not.
CONCLUSIONS: Children requiring bronchoscopy represent a subset of the sickest children on ECMO. Bronchoscopy may provide benefit in children with persistent cardiopulmonary failure who could not otherwise be decannulated. Adverse events are associated with the number of bronchoscopies and the presence of obstructive material.
METHODS: 4 Laryngoscope, 134:4134-4140, 2024.