First-Line Respiratory Support for Children With Hematologic Malignancy and Acute Respiratory Failure.
First-Line Respiratory Support for Children With Hematologic Malignancy and Acute Respiratory Failure.
复制标题
患有血液恶性肿瘤和急性呼吸衰竭的儿童的一线呼吸支持。
DOI：
10.1097/cce.0000000000001076
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发表时间：
2024
影响因子：
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通讯作者：
Kane,JasonM
中科院分区：
文献类型：
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作者：
Asif,Hassaan;McNeer,JenniferL;Ghanayem,NancyS;Cursio,JohnF;Kane,JasonM
目的：描述PICU收治的急性呼吸衰竭（ARF）血液恶性肿瘤患儿无创通气（NIV）和有创机械通气（IMV）的使用趋势，并确定与无创通气失败需要过渡到IMV相关的危险因素。设计：2010年1月1日至2019年12月31日期间使用虚拟儿科系统（VPS， LLC）进行回顾性队列分析。背景：113个北美picu参与VPS。患者：2880名0-21岁的恶性血液病患儿因ARF需要呼吸支持而接受picu治疗。测量方法和主要结果：共有3013例患者，其中868例（28.8%）单独接受了一线NIV（仅使用NIV）， 1544例（51.2%）接受了一线IMV（仅使用IMV）， 601例（19.9%）在NIV试验失败后需要IMV （NIV失败）。从2010年到2019年，NIV组从9.6%上升到43.1%，IMV组从80.1%下降到34.2%（p< 0.001）。NIV失效组与仅使用NIV组和仅使用IMV组相比死亡率最高（36.6%比8.1%，比30.5%,p< 0.001）。然而，与单纯NIV组和NIV失败组相比，仅IMV组的死亡风险（ROM）最高（小儿死亡风险中位数为8.1%、2.8%和5.5%,p< 0.001）。与其他两个研究组相比，NIV失效患者PICU的中位住院时间也最长（15.2天vs. 6.1天和9.0天，p< 0.001）。年龄越大，NIV失败的几率显著降低，与急性淋巴细胞白血病相比，非霍奇金淋巴瘤的诊断与NIV失败的几率显著增加相关。结论：对于因ARF入院PICU的血液恶性肿瘤患儿，NIV已取代IMV成为最常见的初始治疗方法。尽管PICU入院ROM较低，但NIV失败率仍然很高，观察到的死亡率也很高。
OBJECTIVES:To characterize trends in noninvasive ventilation (NIV) and invasive mechanical ventilation (IMV) use over time in children with hematologic malignancy admitted to the PICU with acute respiratory failure (ARF), and to identify risk factors associated with NIV failure requiring transition to IMV.DESIGN:Retrospective cohort analysis using the Virtual Pediatric Systems (VPS, LLC) between January 1, 2010 and December 31, 2019.SETTING:One hundred thirteen North American PICUs participating in VPS.PATIENTS:Two thousand four hundred eighty children 0–21 years old with hematologic malignancy admitted to participating PICUs for ARF requiring respiratory support.INTERVENTIONS:None.MEASUREMENTS AND MAIN RESULTS:There were 3013 total encounters, of which 868 (28.8%) received first-line NIV alone (NIV only), 1544 (51.2%) received first-line IMV (IMV only), and 601 (19.9%) required IMV after a failed NIV trial (NIV failure). From 2010 to 2019, the NIV only group increased from 9.6% to 43.1% and the IMV only group decreased from 80.1% to 34.2%(p< 0.001). The NIV failure group had the highest mortality compared with NIV only and IMV only (36.6% vs. 8.1%, vs. 30.5%, p< 0.001). However, risk-of-mortality (ROM) was highest in the IMV only group compared with NIV only and NIV failure (median Pediatric Risk of Mortality III ROM 8.1% vs. 2.8% vs. 5.5%, p< 0.001). NIV failure patients also had the longest median PICU length of stay compared with the other two study groups (15.2 d vs. 6.1 and 9.0 d, p< 0.001). Higher age was associated with significantly decreased odds of NIV failure, and diagnosis of non-Hodgkin lymphoma was associated with significantly increased odds of NIV failure compared with acute lymphoid leukemia.CONCLUSIONS:For children with hematologic malignancy admitted to the PICU with ARF, NIV has replaced IMV as the most common initial therapy. NIV failure rate remains high with high-observed mortality despite lower PICU admission ROM.