High-frequency oscillatory ventilation and short-term outcome in neonates and infants undergoing cardiac surgery: a propensity score analysis
High-frequency oscillatory ventilation and short-term outcome in neonates and infants undergoing cardiac surgery: a propensity score analysis
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DOI：
10.1186/cc10521
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发表时间：
2011-01-01
期刊：
影响因子：
15.1
通讯作者：
Pouard, Philippe
中科院分区：
文献类型：
--
作者：
Bojan, Mirela;Gioanni, Simone;Pouard, Philippe
简介：尽管有证据表明Fontan手术后肺血管阻力降低，但先天性心脏手术后高频振荡通气（HFOV）的经验有限。HFOV推荐用于急性呼吸窘迫综合征的成人和儿童。本研究的目的是评估心脏手术后呼吸窘迫的新生儿和婴儿在手术当天开始HFOV与机械通气时间、重症监护病房（ICU）住院时间和死亡率之间的关系。方法：采用logistic回归模型建立倾向评分，计算手术当日从常规机械通气（CMV）切换到HFOV的概率。它包括基线特征、手术类型和术后变量，并用于将每个HFOV患者与对照患者进行匹配，对照患者仅使用CMV。比较两组患者机械通气时间、ICU住院时间和死亡率。结果：总的来说，从2001年1月到2010年6月，3549名新生儿和婴儿接受了心脏手术，120名患者切换到HFOV，并与120名对照组相匹配。调整胸骨闭合延迟、肾脏替代治疗时间、肺动脉高压发生率和手术年份后，HFOV患者成功脱机的概率和ICU分娩的概率随时间的变化均显著较高，调整后的风险比和95%置信区间分别为1.63、1.17和2.26 （P = 0.004）。和1.65,95%置信区间分别为1.20 ~ 2.28 （P = 0.002）。未发现与死亡率相关。结论：在新生儿和心脏手术后呼吸窘迫的婴儿手术当天开始时，HFOV与CMV相比，机械通气时间和ICU住院时间较短。
Introduction: Experience with high-frequency oscillatory ventilation (HFOV) after congenital cardiac surgery is limited despite evidence about reduction in pulmonary vascular resistance after the Fontan procedure. HFOV is recommended in adults and children with acute respiratory distress syndrome. The aim of the present study was to assess associations between commencement of HFOV on the day of surgery and length of mechanical ventilation, length of Intensive Care Unit (ICU) stay and mortality in neonates and infants with respiratory distress following cardiac surgery.Methods: A logistic regression model was used to develop a propensity score, which accounted for the probability of being switched from conventional mechanical ventilation (CMV) to HFOV on the day of surgery. It included baseline characteristics, type of procedure and postoperative variables, and was used to match each patient with HFOV with a control patient, in whom CMV was used exclusively. Length of mechanical ventilation, ICU stay and mortality rates were compared in the matched set.Results: Overall, 3,549 neonates and infants underwent cardiac surgery from January 2001 through June 2010, 120 patients were switched to HFOV and matched with 120 controls. After adjustment for the delay to sternal closure, duration of renal replacement therapy, occurrence of pulmonary hypertension and year of surgery, the probability of successful weaning over time and the probability of ICU delivery over time were significantly higher in patients with HFOV, adjusted hazard ratios and 95% confidence intervals: 1.63, 1.17 to 2.26 (P = 0.004). and 1.65, 95% confidence intervals: 1.20 to 2.28 (P = 0.002) respectively. No association was found with mortality.Conclusions: When commenced on the day of surgery in neonates and infants with respiratory distress following cardiac surgery, HFOV was associated with shorter lengths of mechanical ventilation and ICU stay than CMV.