Domenico Paolo La Regina, Brigitte Fauroux, Rocco Di Gioia, Simona Marra, Laura Petrarca, Enrica Mancino, Maria Giulia Conti, Luigi Matera, Greta Di Mattia, Antonella Frassanito, Enea Bonci, Benedetto D'Agostino, Raffaella Nenna, Paola Papoff, Fabio Midulla
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引用次数: 0
Abstract
Objective: To evaluate the impact of the 2023 Italian guidelines on respiratory support management for acute viral bronchiolitis by comparing the use of low-flow oxygen (LFO) and high-flow nasal cannula (HFNC) therapies during the 2022-2023 and 2023-2024 epidemic seasons.
Design: A retrospective, single-centre observational study.
Setting: The paediatric emergency department of Policlinico Umberto I, Rome, Italy.
Patients: A total of 202 infants (<12 months) with hypoxaemia due to acute viral bronchiolitis were hospitalised during the study periods. Eight patients were excluded due to chronic conditions or missing data.
Interventions: The study compared LFO as a first-line therapy and HFNC as a second-line option in cases of LFO failure, before (2022-2023) and after (2023-2024) the guideline update.
Main outcome measures: Rates of LFO and HFNC use, treatment failure, intubation, intensive care unit (ICU) admission, length of hospitalisation and oxygen therapy duration.
Results: HFNC use as a first-line therapy decreased from 43.5% to 5.5%, while LFO use increased from 56.5% to 94.5%. LFO failure rates dropped significantly from 50% to 23%. No significant changes were observed in HFNC failure rates (12.5% vs 16.7%), ICU admissions or intubation rates. The average hospital stay decreased from 5.1±2.3 to 4.1±2.0 days, with a concomitant reduction in oxygen therapy duration.
Conclusions: The 2023 Italian guidelines significantly reduced inappropriate HFNC use and hospital stay length without compromising patient outcomes. These findings support the step-up approach, emphasising LFO as the preferred first-line therapy.
目的:通过比较2022-2023年和2023-2024年流行季节低流量氧(LFO)和高流量鼻插管(HFNC)治疗方法的使用情况,评价2023年意大利指南对急性病毒性细支气管炎呼吸支持管理的影响。设计:回顾性、单中心观察性研究。地点:意大利罗马翁贝托第一医院儿科急诊科。患者:共有202名婴儿(干预措施:该研究比较了在指南更新之前(2022-2023)和之后(2023-2024),LFO作为一线治疗和HFNC作为LFO失败病例的二线选择。主要观察指标:LFO和HFNC使用率、治疗失败、插管、重症监护病房(ICU)入院、住院时间和氧疗持续时间。结果:HFNC作为一线治疗的使用率从43.5%下降到5.5%,而LFO的使用率从56.5%上升到94.5%。LFO失败率从50%显著下降到23%。HFNC失败率(12.5% vs 16.7%)、ICU入院率或插管率均无显著变化。平均住院时间从5.1±2.3天减少到4.1±2.0天,同时氧疗时间缩短。结论:2023年意大利指南在不影响患者预后的情况下显著减少了不适当的HFNC使用和住院时间。这些发现支持逐步的方法,强调LFO是首选的一线治疗方法。