Bronchodilator effect on regional lung function in pediatric viral lower respiratory tract infections.
Bronchodilator effect on regional lung function in pediatric viral lower respiratory tract infections.
复制标题
支气管扩张剂对小儿病毒性下呼吸道感染局部肺功能的影响。
DOI：
10.1088/1361-6579/ac9450
复制
发表时间：
2022
影响因子：
3.2
通讯作者：
Strodthoff C
中科院分区：
文献类型：
--
作者：
Strodthoff C
目的病毒性下呼吸道感染(LRTI)是婴幼儿急性入院的主要原因。雾化吸入的支气管扩张剂通常用于治疗最严重的病例。本研究的目的是通过电阻抗断层扫描(EIT)研究重症监护期间支气管扩张剂对呼吸力学的影响，并评估EIT的可行性。采用观察性研究设计，对胸部EIT患儿进行长达72小时的连续监测。由于临床医生在数据收集过程中对EIT信息视而不见，治疗决定是通过临床评估来完成的。在一项回顾分析中，临床参数和EIT测定的局部呼气时间常数被用来评估使用支气管扩张剂的效果，特别是对呼吸道阻力的影响。主要结果包括6名11至27个月的儿童，因病毒性下呼吸道感染而需要重症监护并接受支气管扩张剂治疗。在EIT监测期间，总共确定了131种支气管扩张剂给药。在对事件的确切时间和经济转型数据质量进行确认后，最终分析纳入了77个行政当局。其中55例发生在有创机械通气期间，22例发生在高流量鼻腔插管治疗期间。只有17%的支气管扩张剂给药导致计算的呼气时间常数相应减少。重要的是，持续监测EIT可能有助于优化儿科重症监护病房LRTI的治疗。特别是，基于EIT的区域呼气时间常数将允许客观评估支气管扩张剂和其他呼吸疗法的效果。
ObjectiveViral lower respiratory tract infections (LRTI) are the leading cause for acute admission to the intensive care unit in infants and young children. Nebulized bronchodilators are often used when treating the most severe cases. The aim of this study was to investigate the bronchodilator effect on respiratory mechanics during intensive care with electrical impedance tomography (EIT) and to assess the feasibility of EIT in this context.ApproachWe continuously monitored the children with chest EIT for up to 72 h in an observational study design. The treatment decisions were done by clinical assessment, as the clinicians were blinded to the EIT information during data collection. In a retrospective analysis, clinical parameters and regional expiratory time constants determined by EIT were used to assess the effects of bronchodilator administration, especially regarding airway resistance.Main resultsWe included six children from 11 to 27 months of age requiring intensive care due to viral LRTI and receiving bronchodilator agents. Altogether 131 bronchodilator administrations were identified during EIT monitoring. After validation of the exact timing of events and EIT data quality, 77 administrations were included in the final analysis. Fifty-five bronchodilator events occurred during invasive ventilation and 22 during high-flow nasal cannulae treatment. Only 17% of the bronchodilator administrations resulted in a relevant decrease in calculated expiratory time constants.SignificanceContinuous monitoring with EIT might help to optimize the treatment of LRTI in pediatric intensive care units. In particular, EIT-based regional expiratory time constants would allow objective assessment of the effects of bronchodilators and other respiratory therapies.