Invasive and noninvasive ventilation strategies for acute respiratory failure in children with coronavirus disease 2019.
Invasive and noninvasive ventilation strategies for acute respiratory failure in children with coronavirus disease 2019.
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DOI：
10.1097/mop.0000000000001021
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发表时间：
2021-06-01
影响因子：
3.6
通讯作者：
Duvall MG
中科院分区：
文献类型：
--
作者：
Blumenthal JA;Duvall MG
严重急性呼吸综合征冠状病毒2型在易感患者中表现为症状性新冠肺炎病。严重的儿科新冠肺炎病是罕见的，限制了儿童相关呼吸衰竭的潜在数据积累。管理新冠肺炎患者的儿科重症医生和肺科医生希望通过成人指南和儿科特有的共识声明来指导管理。本文的目的是回顾当前文献和推荐的策略，以逐步无创和有创的呼吸支持治疗儿童新冠肺炎相关性急性呼吸衰竭。目前还没有对儿童新冠肺炎治疗策略进行比较的前瞻性研究。成人和儿童呼吸机管理临时指南以非COVID急性呼吸窘迫综合征的循证指南为基础，考虑了1)无创正压通气与高流量鼻插管，以及2)与肺顺应性和潜在的肺招募能力相关的高PEEP与低PEEP策略。新冠肺炎急性呼吸衰竭的治疗需要对无创和有创机械通气方式进行个体化滴定，同时考虑到肺顺应性的保存或受损。关于儿童重症新冠肺炎合并呼吸衰竭的管理最佳做法的研究是缺乏的，由于大流行激增和儿童人口的疫苗接种将比成人延迟，因此迫切需要这方面的研究。
Severe Acute Respiratory Syndrome Coronavirus 2 presents as symptomatic COVID-19 disease in susceptible patients. Severe pediatric COVID-19 disease is rare, limiting potential data accumulation on associated respiratory failure in children. Pediatric intensivists and pulmonologists managing COVID-19 patients look to adult guidelines and pediatric-specific consensus statements to guide management. The purpose of this article is to review the current literature and recommended strategies for escalation of non-invasive and invasive respiratory support for acute respiratory failure associated with COVID-19 disease in children. There are no prospective studies comparing COVID-19 treatment strategies in children. Adult and pediatric ventilation management interim guidance is based on evidence-based guidelines in non-COVID acute respiratory distress syndrome, with considerations of 1) non-invasive positive pressure ventilation versus high-flow nasal cannula and 2) high versus lower PEEP strategies related to lung compliance and potential lung recruitability. Management of acute respiratory failure from COVID-19 requires individualized titration of non-invasive and invasive ventilation modalities with consideration of preserved or compromised pulmonary compliance. Research regarding best practices in management of pediatric severe COVID-19 with respiratory failure is lacking and is acutely needed as the pandemic surges and vaccination of the pediatric population will be delayed compared to adults.