Critical care for pediatric asthma: wide care variability and challenges for study.
Critical care for pediatric asthma: wide care variability and challenges for study.
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DOI：
10.1097/pcc.0b013e318238b428
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发表时间：
2012-07
期刊：
影响因子：
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通讯作者：
Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network
中科院分区：
文献类型：
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作者：
Bratton SL;Newth CJ;Zuppa AF;Moler FW;Meert KL;Berg RA;Berger J;Wessel D;Pollack M;Harrison R;Carcillo JA;Shanley TP;Liu T;Holubkov R;Dean JM;Nicholson CE;Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network
描述儿科严重哮喘护理、并发症和结果，以规划儿科重症护理合作研究网络 (CPCCRN) 未来的前瞻性研究。回顾性队列研究。美国的儿科重症监护病房 (PICU) 向儿科健康信息系统 (PHIS) 提交管理数据。 2004 年至 2008 年间，因哮喘而在 PHIS PICU 接受治疗的 1-18 岁儿童。没有对 13,552 名儿童进行研究； 2,812 例 (21%) 在 CPCCRN 接受治疗，10,740 例 (79%) 在非 CPCCRN PICU 接受治疗。各个 CPCCRN 中心的药物使用情况差异很大：异丙托溴铵 (41-84%)、特布他林 (11-74%)、硫酸镁 (23-64%) 和甲基黄嘌呤 (0-46%)。气胸（0-0.6%）、心脏骤停（0.2-2%）和误吸（0.2-2%）等并发症很少见。 CPCCRN 中心的药物治疗和并发症的总体使用情况代表了非 CPCCRN PICU 的儿科哮喘护理。 CPCCRN 中心的 PICU 住院时间中位为 1 至 2 天，死亡很少见（0.1-3%）。在 CPCCRN 中心接受治疗的儿童中有 10% 接受了有创机械通气，而在非 CPCCRN 中心接受治疗的儿童为 12%。总共 44% 接受有创机械通气的患者在 PICU 接受插管。与 PICU 内插管的儿童相比，在 PICU 外插管的儿童的中位通气天数（1 比 3）、PICU 天（2 比 4）和住院天（4 比 7）显着缩短。在接受机械呼吸支持的儿童中，接受无创通气治疗的儿童明显较多（41% vs. 25%），而在 PHIS 医院急诊科接受 PICU 护理之前插管的儿童则明显较少（41% vs. 58%）。药物治疗和机械支持存在明显差异。死亡和其他并发症很少见。超过一半接受机械通气治疗的患者在进入 PICU 护理之前已插管。呼吸机械支持开始的部位与住院时间相关。
To describe pediatric severe asthma care, complications and outcomes to plan for future prospective studies by the Collaborative Pediatric Critical Care Research Network (CPCCRN). Retrospective cohort study. Pediatric intensive care units (PICU)s in the United States that submit administrative data to the Pediatric Health Information System (PHIS). Children 1-18 years treated in a PHIS PICU for asthma during 2004 to 2008. None 13,552 children were studied; 2,812 (21%) treated in a CPCCRN and 10,740 (79%) in a non-CPCCRN PICU. Medication use in individual CPCCRN centers differed widely: ipratropium bromide (41-84%) terbutaline (11-74%), magnesium sulfate (23-64%) and methylxanthines (0-46%). Complications including pneumothorax (0-0.6%), cardiac arrest (0.2-2%) and aspiration (0.2-2%) were rare. Overall use of medical therapies and complications at CPCCRN centers were representative of pediatric asthma care at non-CPCCRN PICUs. Median length of PICU stay at CPCCRN centers was 1 to 2 days and death was rare (0.1-3%). Ten percent of children treated at CPCCRN centers received invasive mechanical ventilation compared to12 percent at non-CPCCRN centers. Overall 44% of patients who received invasive mechanical ventilation were intubated in the PICU. Children intubated outside the PICU had significantly shorter median ventilation days (1 vs.3), PICU days (2 vs. 4) and hospital days (4 vs. 7) compared to those intubated in the PICU. Among children who received mechanical respiratory support significantly more (41 vs. 25%) were treated with non-invasive ventilation and significantly fewer (41 vs. 58%) were intubated prior to PICU care when treated in a PHIS hospital emergency department. Marked variations in medication therapies and mechanical support exist. Death and other complications were rare. Over half of patients treated with mechanical ventilation were intubated prior to PICU care. Site of respiratory mechanical support initiation is associated with length of stay.