Early Use of Adjunctive Therapies for Pediatric Acute Respiratory Distress Syndrome: A PARDIE Study
Early Use of Adjunctive Therapies for Pediatric Acute Respiratory Distress Syndrome: A PARDIE Study
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DOI：
10.1164/rccm.201909-1807oc
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发表时间：
2020-06-01
影响因子：
24.7
通讯作者：
Yehya, Nadir
中科院分区：
文献类型：
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作者：
Rowan, Courtney M.;Klein, Margaret J.;Yehya, Nadir
基本原理：目前很少有数据能够指导儿童急性呼吸窘迫综合征（PARDS）早期连续治疗的使用。目的：描述当前早期PARDS连续治疗的使用，作为未来研究的框架。方法：这是一项预先计划的子研究，对来自100个中心的PARDS儿童进行了为期10周的前瞻性、国际性、横断面观察性研究。测量和主要结果：我们研究了PARDS的六种连续治疗：连续神经肌肉阻滞、皮质类固醇、吸入一氧化氮（iNO）、俯卧位、高频振荡通气（HFOV）和体外膜肺氧合。几乎一半（45%）的PARDS儿童接受了至少一种治疗。观察到每种治疗的中位起始氧合指数存在变异性;皮质类固醇在最低氧合指数（13.0;四分位数间距，7.6-22.0）时开始，HFOV在最高氧合指数（25.7;四分位数间距，16.7-37.3）时开始。连续性神经肌肉阻滞是最常见的，使用率为31%，其次是iNO（13%）、皮质类固醇（10%）、俯卧位（10%）、HFOV（9%）和体外膜肺氧合（3%）。类固醇、iNO和HFOV与合并症相关。俯卧位和HFOV在中等收入国家更常见，在北美使用频率较低。使用多种辅助治疗增加了PARDS的前3天，但没有一个容易识别的模式组合或顺序use.Conclusions：当代描述的患病率，组合的治疗方法，和氧合阈值的治疗应用是很重要的设计未来的研究。世界的地区、收入和合并症影响了连续治疗的使用，是PARDS研究中包括的重要变量。
Rationale: Few data exist to guide early adjunctive therapy use in pediatric acute respiratory distress syndrome (PARDS).Objectives: To describe contemporary use of adjunctive therapies for early PARDS as a framework for future investigations.Methods: This was a preplanned substudy of a prospective, international, cross-sectional observational study of children with PARDS from 100 centers over 10 study weeks.Measurements and Main Results: We investigated six adjunctive therapies for PARDS: continuous neuromuscular blockade, corticosteroids, inhaled nitric oxide (iNO), prone positioning, high-frequency oscillatory ventilation (HFOV), and extracorporeal membrane oxygenation. Almost half (45%) of children with PARDS received at least one therapy. Variability was noted in the median starting oxygenation index of each therapy; corticosteroids started at the lowest oxygenation index (13.0; interquartile range, 7.6-22.0) and HFOV at the highest (25.7; interquartile range, 16.7-37.3). Continuous neuromuscular blockade was the most common, used in 31%, followed by iNO (13%), corticosteroids (10%), prone positioning (10%), HFOV (9%), and extracorporeal membrane oxygenation (3%). Steroids, iNO, and HFOV were associated with comorbidities. Prone positioning and HFOV were more common in middle-income countries and less frequently used in North America. The use of multiple ancillary therapies increased over the first 3 days of PARDS, but there was not an easily identifiable pattern of combination or order of use.Conclusions: The contemporary description of prevalence, combinations of therapies, and oxygenation threshold for which the therapies are applied is important for design of future studies. Region of the world, income, and comorbidities influence adjunctive therapy use and are important variables to include in PARDS investigations.