Journal of Pediatric Intensive Care最新文献_第2页

Effect of Target-Driven Sedation Protocol to Ventilator Liberation in Pediatric Intensive Care Unit: Pre- and Postimplementation Single-Center Study 目标驱动镇静方案对儿童重症监护病房呼吸机解放的影响:实施前后单中心研究

Journal of Pediatric Intensive Care Pub Date : 2023-09-19 DOI: 10.1055/s-0043-1774306

Abdulla Alfraij, Ahmed Abdelmoniem, Mohammad Surour, Mohamed Basuni, Mohamed Elseadawy

{"title":"Effect of Target-Driven Sedation Protocol to Ventilator Liberation in Pediatric Intensive Care Unit: Pre- and Postimplementation Single-Center Study","authors":"Abdulla Alfraij, Ahmed Abdelmoniem, Mohammad Surour, Mohamed Basuni, Mohamed Elseadawy","doi":"10.1055/s-0043-1774306","DOIUrl":"https://doi.org/10.1055/s-0043-1774306","url":null,"abstract":"Abstract Oversedation of mechanically ventilated children is common in many pediatric intensive care units (PICUs). This practice is driven by the challenges of dealing with children of different ages as they have different behavioral, mental, and emotional statuses. We aimed to evaluate the effect of implementing a target-driven sedation protocol in the PICU on ventilator-free days (VFDs), PICU stays, and hospitalization. A 2-year retrospective cohort study was performed in our PICU between October 1, 2018, and October 1, 2020. All intubated children up to 12 years of age were included. Descriptive analyses and a pre- and postintervention comparison of VFDs and length of stay were used to assess the protocol's effectiveness. A total of 134 patients were studied. There was a significant increase in VFDs in cases with respiratory illness requiring mechanical ventilation after implementing this protocol (19.9 vs. 22.3, respectively, with a p-value of 0.031). Also, there was a trend of reduction in the length of PICU stay (median of 9 vs. 8 days, p = 0.816), post-PICU length of stay (median of 4 vs. 3 days, p = 0.055), and hospitalization duration (median of 16 vs. 13 days, p = 0.062) though not statistically significant. Implementing a target-driven sedation protocol in the PICU significantly affects VFDs in mechanically ventilated respiratory cases. Though inconclusive in our study, implementing such a protocol will influence patients' care and reduce unnecessary sedation uses that will reduce sedation hazards.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135059281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Perioperative Management of Pediatric Patients with Moyamoya Arteriopathy. 小儿烟雾动脉病的围手术期处理。

IF 0.7

Journal of Pediatric Intensive Care Pub Date : 2023-09-01 DOI: 10.1055/s-0041-1731667

Sarah E Gardner Yelton, Monica A Williams, Mollie Young, Jennifer Fields, Monica S Pearl, James F Casella, Courtney E Lawrence, Ryan J Felling, Eric M Jackson, Courtney Robertson, Susanna Scafidi, Jennifer K Lee, Alan R Cohen, Lisa R Sun

{"title":"Perioperative Management of Pediatric Patients with Moyamoya Arteriopathy.","authors":"Sarah E Gardner Yelton, Monica A Williams, Mollie Young, Jennifer Fields, Monica S Pearl, James F Casella, Courtney E Lawrence, Ryan J Felling, Eric M Jackson, Courtney Robertson, Susanna Scafidi, Jennifer K Lee, Alan R Cohen, Lisa R Sun","doi":"10.1055/s-0041-1731667","DOIUrl":"https://doi.org/10.1055/s-0041-1731667","url":null,"abstract":"Pediatric patients with moyamoya arteriopathy are at high risk for developing new onset transient or permanent neurologic deficits secondary to cerebral hypoperfusion, particularly in the perioperative period. It is therefore essential to carefully manage these patients in a multidisciplinary, coordinated effort to reduce the risk of new permanent neurologic deficits. However, little has been published on perioperative management of pediatric patients with moyamoya, particularly in the early postoperative period during intensive care unit admission. Our pediatric neurocritical care team sought to create a multidisciplinary periprocedural evidence- and consensus-based care pathway for high-risk pediatric patients with moyamoya arteriopathy undergoing anesthesia for any reason to decrease the incidence of periprocedural stroke or transient ischemic attack (TIA). We reviewed the literature to identify risk factors associated with perioperative stroke or TIA among patients with moyamoya and to gather data supporting specific perioperative management strategies. A multidisciplinary team from pediatric anesthesia, neurocritical care, nursing, child life, neurosurgery, interventional neuroradiology, neurology, and hematology created a care pathway for children with moyamoya undergoing anesthesia, classifying them as either high or standard risk, and applying an individualized perioperative management plan to high-risk patients. The incidence of neurologic sequelae before and after pathway implementation will be compared in future studies.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10411150/pdf/10-1055-s-0041-1731667.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10033153","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 10

Response to the Letter to the Editor: Inborn Errors in Pediatric Intensive Care Unit: Much More to Understand. 给编辑的信的回应:儿科重症监护病房的先天性错误:更多的了解。

IF 0.7

Journal of Pediatric Intensive Care Pub Date : 2023-09-01 DOI: 10.1055/s-0041-1731023

Patrícia Lipari Pinto, Zakhar Shchomak, Leonor Boto, Patrícia Janeiro, Oana Moldovan, Francisco Abecasis, Ana Gaspar, Marisa Vieira

引用次数: 0

Safety and Feasibility of Long-Distance Aeromedical Transport of Neonates and Children in Fixed-Wing Air Ambulance. 固定翼空中救护新生儿和儿童远程医疗运输的安全性和可行性。

IF 0.7

Journal of Pediatric Intensive Care Pub Date : 2023-09-01 DOI: 10.1055/s-0041-1731681

Alex Veldman, Stefanie Krummer, Dirk Schwabe, Michael Diefenbach, Doris Fischer, Sophie Schmitt-Kästner, Cornelia Rohrbeck, Ruby Pannu

{"title":"Safety and Feasibility of Long-Distance Aeromedical Transport of Neonates and Children in Fixed-Wing Air Ambulance.","authors":"Alex Veldman, Stefanie Krummer, Dirk Schwabe, Michael Diefenbach, Doris Fischer, Sophie Schmitt-Kästner, Cornelia Rohrbeck, Ruby Pannu","doi":"10.1055/s-0041-1731681","DOIUrl":"https://doi.org/10.1055/s-0041-1731681","url":null,"abstract":"In cases of critical injury or illness abroad, fixed-wing air ambulance aircraft is employed to repatriate children to their home country. Air ambulance aircraft also transport children to foreign countries for treatment not locally available and newborns back home that have been born prematurely abroad. In this retrospective observational study, we investigated demographics, feasibility, and safety and outcomes of long-distance and international aeromedical transport of neonates and children. The study included 167 pediatric patients, 56 of those preterm neonates. A total of 41 patients were ventilated, 45 requiring oxygen prior to the transport, 57 transferred from an intensive care unit (ICU), and 48 to an ICU. Patients were transported by using Learjet 31A, Learjet 45, Learjet 55, and Bombardier Challenger 604, with a median transport distance of 1,008 nautical miles (NM), median transport time of 04:45 hours (median flight time = 03:00 hours), flight time ≥8 hours in 15 flights, and transport time ≥8 hours in 29 missions. All transports were accompanied by a pediatric physician/nurse team. An increase in FiO 2 during the transport was documented in 47/167 patients (28%). Therapy escalation (other than increased oxygen) was reported in 18 patients, and technical adverse events in 3 patients. No patient required CPR or died during the transport. Clinical transport outcome was rated by the accompanying physician as unchanged in 163 transports, improved in 4, and deteriorated in none. In summary, international, long-distance transport of neonatal and pediatric patients performed by experienced and well-equipped transport teams is feasible. Neither major adverse events nor physician-rated clinical deteriorations were observed in this group of patients.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/60/00/10-1055-s-0041-1731681.PMC10411161.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9979474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Troponin I as an Independent Biomarker of Outcome in Children with Systemic Inflammatory Response. 肌钙蛋白I作为全身性炎症反应儿童预后的独立生物标志物。

IF 0.7

Journal of Pediatric Intensive Care Pub Date : 2023-09-01 DOI: 10.1055/s-0041-1731432

Heitor P Leite, Rodrigo Medina, Emilio L Junior, Tulio Konstantyner

{"title":"Troponin I as an Independent Biomarker of Outcome in Children with Systemic Inflammatory Response.","authors":"Heitor P Leite, Rodrigo Medina, Emilio L Junior, Tulio Konstantyner","doi":"10.1055/s-0041-1731432","DOIUrl":"https://doi.org/10.1055/s-0041-1731432","url":null,"abstract":"Cardiac troponin-I (cTnI) is a biomarker of myocardial injury with implications for clinical outcomes. May other contributing factors that could affect outcomes have not been uniformly considered in pediatric studies. We hypothesized that there is an association between admission serum cTnI and outcomes in critically ill children taking into account the magnitude of the acute systemic inflammatory response syndrome (SIRS), serum lactate concentrations, and nutritional status. Second, we tested for potential factors associated with elevated serum cTnI. This was a prospective cohort study in 104 children (median age: 21.3 months) consecutively admitted to a pediatric intensive care unit (PICU) of a teaching hospital with SIRS and without previous chronic diseases. Primary outcome variables were PICU-free days, ventilator-free days, and 30-day mortality. Exposure variables were serum cTnI concentration on admission, revised pediatric index of mortality (PIM2), pediatric logistic organ dysfunction (PELOD-2), hypotensive shock, C-reactive protein, procalcitonin, and serum lactate on admission, and malnutrition. Elevated cTnI (>0.01 μg/L) was observed in 24% of patients, which was associated with the reduction of ventilator-free days (β coefficient = - 4.97; 95% confidence interval [CI]: -8.03; -1.91) and PICU-free days (β coefficient = - 5.76; 95% CI: -8.97; -2.55). All patients who died had elevated serum cTnI. The increase of 0.1 μg/L in cTnI concentration resulted in an elevation of 2 points in the oxygenation index (β coefficient = 2.0; 95% CI: 1.22; 2.78, p < 0.001). The PIM2 score, hypotensive shock in the first 24 hours, and serum lactate were independently associated with elevated cTnI on admission. We conclude that elevated serum cTnI on admission is independently associated with adverse outcomes in children with SIRS and without associated chronic diseases.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10411187/pdf/10-1055-s-0041-1731432.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9979475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Predictors of Failure of Noninvasive Ventilation in Critically Ill Children. 危重儿童无创通气失败的预测因素。

IF 0.7

Journal of Pediatric Intensive Care Pub Date : 2023-09-01 DOI: 10.1055/s-0041-1731433

Alyson K Baker, Andrew L Beardsley, Brian D Leland, Elizabeth A Moser, Riad L Lutfi, A Ioana Cristea, Courtney M Rowan

{"title":"Predictors of Failure of Noninvasive Ventilation in Critically Ill Children.","authors":"Alyson K Baker, Andrew L Beardsley, Brian D Leland, Elizabeth A Moser, Riad L Lutfi, A Ioana Cristea, Courtney M Rowan","doi":"10.1055/s-0041-1731433","DOIUrl":"https://doi.org/10.1055/s-0041-1731433","url":null,"abstract":"Noninvasive ventilation (NIV) is a common modality employed to treat acute respiratory failure. Most data guiding its use is extrapolated from adult studies. We sought to identify clinical predictors associated with failure of NIV, defined as requiring intubation. This single-center retrospective observational study included children admitted to pediatric intensive care unit (PICU) between July 2014 and June 2016 treated with NIV, excluding postextubation. A total of 148 patients was included. Twenty-seven (18%) failed NIV. There was no difference between the two groups with regard to age, gender, comorbidities, or etiology of acute respiratory failure. Those that failed had higher admission pediatric risk of mortality ( p = 0.01) and pediatric logistic organ dysfunction ( p = 0.002) scores and higher fraction of inspired oxygen (FiO 2 ; p = 0.009) at NIV initiation. Failure was associated with lack of improvement in tachypnea. At 6 hours of NIV, the failure group had worsening tachypnea with a median increase in respiratory rate of 8%, while the success group had a median reduction of 18% ( p = 0.06). Multivariable Cox's proportional hazard models revealed FiO 2 at initiation and worsening respiratory rate at 1- and 6-hour significant risks for failure of NIV. Failure was associated with a significantly longer PICU length of stay (success [2.8 days interquartile range (IQR): 1.7, 5.5] vs. failure [10.6 days IQR: 5.6, 13.2], p < 0.001). NIV can be successfully employed to treat acute respiratory failure in pediatric patients. There should be heightened concern for NIV failure in hypoxemic patients whose tachypnea is unresponsive to NIV. A trend toward improvement should be closely monitored.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10411242/pdf/10-1055-s-0041-1731433.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10033148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Prothrombin Complex Concentrate Utilization in Children's Hospitals. 凝血酶原浓缩液在儿童医院的应用。

IF 0.7

Journal of Pediatric Intensive Care Pub Date : 2023-09-01 DOI: 10.1055/s-0041-1731686

Jeffrey E Lutmer, Christian Mpody, Eric A Sribnick, Takaharu Karube, Joseph D Tobias

{"title":"Prothrombin Complex Concentrate Utilization in Children's Hospitals.","authors":"Jeffrey E Lutmer, Christian Mpody, Eric A Sribnick, Takaharu Karube, Joseph D Tobias","doi":"10.1055/s-0041-1731686","DOIUrl":"https://doi.org/10.1055/s-0041-1731686","url":null,"abstract":"Prothrombin complex concentrates (PCCs) are used to manage bleeding in critically ill children. We performed a repeat cross-sectional study using the Pediatric Health Information System registry to describe PCC utilization in the U.S. children's hospitals over time and determine the relationship between PCC use and specific risk factors for bleeding. We included children < 18 years who received three-factor or four-factor PCC during hospital admission between January 2015 and December 2020 to describe the association between PCC therapy, anticoagulation therapies, and inherited or acquired bleeding diatheses. PCC use steadily increased over the 6-year study period (from 1.3 to 4.6 per 10,000 encounters). Patients exhibited a high degree of critical illness, with 85.0% requiring intensive care unit admission and a mortality rate of 25.8%. PCCs were used in a primarily emergent or urgent fashion (32.6 and 39.3%, respectively) and more frequently in surgical cases (79.0% surgical vs. 21.0% medical). Coding analysis suggested a low rate of chronic anticoagulant use which was supported by review of concomitant anticoagulant medications. PCC use is increasing in critically ill children and does not correlate with specific anticoagulant therapy use or other bleeding risk factors. These findings suggest PCC use is not limited to vitamin K antagonist reversal. Indications, efficacy, and safety of PCC therapy in children require further study.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10411157/pdf/10-1055-s-0041-1731686.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9979479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Description and Validation of a Novel Score (Flow Index) as a Clinical Indicator of the Level of Respiratory Support to Children on High Flow Nasal Cannula. 新评分(流量指数)作为高流量鼻插管儿童呼吸支持水平的临床指标的描述和验证。

IF 0.7

Journal of Pediatric Intensive Care Pub Date : 2023-09-01 DOI: 10.1055/s-0041-1731021

Sandeep Tripathi, Jeremy S Mcgarvey, Nadia Shaikh, Logan J Meixsell

{"title":"Description and Validation of a Novel Score (Flow Index) as a Clinical Indicator of the Level of Respiratory Support to Children on High Flow Nasal Cannula.","authors":"Sandeep Tripathi, Jeremy S Mcgarvey, Nadia Shaikh, Logan J Meixsell","doi":"10.1055/s-0041-1731021","DOIUrl":"https://doi.org/10.1055/s-0041-1731021","url":null,"abstract":"This study's objective was to describe and validate flow index (flow rate × FiO 2 /weight) as a method to report the degree of respiratory support by high flow nasal cannula (HFNC) in children. We conducted a retrospective chart review of children managed with HFNC from January 1, 2015 to December 31, 2019. Variables included in the flow index (weight, fraction of inspired oxygen [FiO 2 ], flow rate) and outcomes (hospital and intensive care unit [ICU] length of stay [LOS], escalation to the ICU) were extracted from medical records. Max flow index was defined by the earliest timestamp when patients FiO 2 × flow rate was maximum. Step-wise regression was used to determine the relationship between outcome (LOS and escalation to ICU) and flow index. Fifteen hundred thirty-seven patients met the study criteria. The median first and maximum flow indexes of the population were 24.1 and 38.1. Both first and maximum flow indexes showed a significant correlation with the LOS ( r = 0.25 and 0.31, p < 0.001). Correlation for the index was stronger than that of the variables used to calculate them and remained significant after controlling for age, race, sex, and diagnoses. Mild, moderate, and severe categories of first and max flow index were derived using quartiles, and they showed significant age and diagnosis independent association with LOS. Patients with first flow index >20 and maximum flow index >59.5 had increased odds ratio of escalation to ICU (odds ratio: 2.39 and 8.08). The first flow index had a negative association with rapid response activation. Flow index is a valid measure for assessing the degree of respiratory support for children on HFNC.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10411057/pdf/10-1055-s-0041-1731021.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9979476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Performance of Platelet Mass Index as a Marker of Severity for Sepsis and Septic Shock in Children. 血小板质量指数作为儿童脓毒症和感染性休克严重程度的指标。

IF 0.7

Journal of Pediatric Intensive Care Pub Date : 2023-09-01 DOI: 10.1055/s-0041-1731434

Madhuradhar Chegondi, Niranjan Vijayakumar, Ramya Deepthi Billa, Aditya Badheka, Oliver Karam

{"title":"Performance of Platelet Mass Index as a Marker of Severity for Sepsis and Septic Shock in Children.","authors":"Madhuradhar Chegondi, Niranjan Vijayakumar, Ramya Deepthi Billa, Aditya Badheka, Oliver Karam","doi":"10.1055/s-0041-1731434","DOIUrl":"https://doi.org/10.1055/s-0041-1731434","url":null,"abstract":"Platelet mass index (PMI) as a prognostic indicator in pediatric sepsis has not been previously reported. In this retrospective observational study, we evaluated PMI's performance as a prognostic indicator in children aged younger than 18 years with sepsis and septic shock in relationship with survival. Over 5 years, we collected data from 122 children admitted to our pediatric intensive care unit (PICU). PMI accuracy was assessed with sensitivity and specificity and its discrimination was assessed using the area under the receiver operating characteristic curve (AUC). Median PMI values on days 1 and 3 of PICU admission were lower among nonsurvivors. On day 1 of PICU admission, a cutoff PMI value of 1,450 fL/nL resulted in a sensitivity of 72% and a specificity of 69%, and the AUC was 0.70 (95% confidence interval [CI]: 0.55-0.86). Similarly, on day 3, a cutoff of 900 fL/nL resulted in a sensitivity of 71% and a specificity of 70%, and the AUC was 0.76 (95% CI: 0.59-0.92). Our exploratory study suggests that low PMI in children with septic shock is associated with increased mortality. Considering the PMI's fair performance, further studies should be performed to assess its clinical value.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10411082/pdf/10-1055-s-0041-1731434.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9981676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 2

Extubation to High-Flow Nasal Cannula in Infants Following Cardiac Surgery: A Retrospective Cohort Study. 婴儿心脏手术后拔管至高流量鼻插管:一项回顾性队列研究。

IF 0.7

Journal of Pediatric Intensive Care Pub Date : 2023-09-01 DOI: 10.1055/s-0041-1730933

Hannah Stevens, Julien Gallant, Jennifer Foster, David Horne, Kristina Krmpotic

{"title":"Extubation to High-Flow Nasal Cannula in Infants Following Cardiac Surgery: A Retrospective Cohort Study.","authors":"Hannah Stevens, Julien Gallant, Jennifer Foster, David Horne, Kristina Krmpotic","doi":"10.1055/s-0041-1730933","DOIUrl":"https://doi.org/10.1055/s-0041-1730933","url":null,"abstract":"High-flow nasal cannula (HFNC) therapy is commonly used in the pediatric intensive care unit (PICU) for postextubation respiratory support. This hypothesis-generating retrospective cohort study aimed to compare postextubation PICU length of stay in infants extubated to HFNC and low flow oxygen (LF) in PICU following cardiac surgery. Of 136 infants (newborn to 1 year) who were intubated and mechanically ventilated in PICU following cardiac surgery, 72 (53%) were extubated to HFNC and 64 (47%) to LF. Compared with patients extubated to LF, those extubated to HFNC had significantly longer durations of cardiopulmonary bypass (152 vs. 109 minutes; p = 0.002), aortic cross-clamp (90 vs. 63 minutes; p = 0.003), and invasive mechanical ventilation (3.2 vs. 1.6 days; p < 0.001), although demographic and preoperative clinical variables were similar. No significant difference was observed in postextubation PICU length of stay between HFNC and LF groups in unadjusted analysis (3.3 vs. 2.6 days, respectively; p = 0.19) and after controlling for potential confounding variables (F [1,125] = 0.17, p = 0.68, R 2 = 0.16). Escalation of therapy was similar between HFNC and LF groups (8.3 vs. 14.1%; p = 0.41). HFNC was effective as rescue therapy for six patients in the LF group requiring escalation of therapy. Need for reintubation was similar between HFNC and LF groups (8.3 vs. 4.7%; p = 0.5). Although extubation to HFNC was associated with a trend toward longer postextubation PICU length of stay and was successfully used as rescue therapy for several infants extubated to LF, our results must be interpreted with caution given the limitations of our study.","PeriodicalId":44426,"journal":{"name":"Journal of Pediatric Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10411109/pdf/10-1055-s-0041-1730933.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9979473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0