Predictive monitoring for respiratory decompensation leading to urgent unplanned intubation in the neonatal intensive care unit.
Predictive monitoring for respiratory decompensation leading to urgent unplanned intubation in the neonatal intensive care unit.
复制标题
DOI：
10.1038/pr.2012.155
复制
发表时间：
2013-01
影响因子：
3.6
通讯作者：
Moorman JR
中科院分区：
文献类型：
--
作者：
Clark MT;Vergales BD;Paget-Brown AO;Smoot TJ;Lake DE;Hudson JL;Delos JB;Kattwinkel J;Moorman JR
新生儿重症监护室（NICU）收治的婴儿，特别是出生时体重极低（VLBW; <1500 g）的婴儿，有呼吸失代偿的风险，需要气管插管和机械通气。插管和机械通气与发病率增加有关，特别是在紧急的计划外病例中。我们检验了以下假设：与呼吸失代偿相关的全身反应可以通过生理监测检测到，床旁监测数据的统计模型可以识别紧急、计划外插管风险增加的婴儿。我们研究了287名连续入住我们NICU的VLBW婴儿，发现51名患者发生了96起事件，不包括前一次拔管后12小时内发生的插管。按照多变量统计模型的重要性顺序，我们发现氧饱和度降低的特征，尤其是心率下降时，心率与呼吸率的相关性增加，以及呼吸暂停的数量都是显著的独立预测因素。预测模型，通过自助法内部验证，具有0.84 ± 0.04的受试者工作特征面积。我们建议在NICU中对紧急计划外插管进行预测性监测，可以通过允许临床医生在需要插管前进行非侵入性干预来改善结局。
Infants admitted to the neonatal intensive care unit (NICU), and especially those born with very low birth weight (VLBW; <1500 grams), are at risk for respiratory decompensation requiring endotracheal intubation and mechanical ventilation. Intubation and mechanical ventilation are associated with increased morbidity, particularly in urgent unplanned cases. We tested the hypothesis that the systemic response associated with respiratory decompensation can be detected from physiological monitoring, and that statistical models of bedside monitoring data can identify infants at increased risk of urgent, unplanned intubation. We studied 287 VLBW infants consecutively admitted to our NICU and found 96 events in 51 patients, excluding intubations occurring within 12 hours of a previous extubation. In order of importance in a multivariable statistical model, we found the characteristics of reduced O2 saturation, especially as heart rate was falling, increased heart rate correlation with respiratory rate, and the amount of apnea all were significant independent predictors. The predictive model, validated internally by bootstrap, had receiver-operating characteristic area of 0.84 ± 0.04. We propose that predictive monitoring in the NICU for urgent unplanned intubation may improve outcomes by allowing clinicians to intervene non-invasively before intubation is required.