单心室生理学儿童气管切开术后的临床结果:儿科心脏重症监护协会多中心队列合作研究,2010-2021 年。

IF 4 2区 医学 Q1 CRITICAL CARE MEDICINE
Pediatric Critical Care Medicine Pub Date : 2024-08-01 Epub Date: 2024-04-29 DOI:10.1097/PCC.0000000000003523
Christopher W Mastropietro, Peter Sassalos, Christine M Riley, Kurt Piggott, Kiona Y Allen, Elizabeth Prentice, Raya Safa, Jason R Buckley, David K Werho, Martin Wakeham, Arthur Smerling, Andrew R Yates, Ilias Iliopoulos, Hitesh Sandhu, Saurabh Chiwane, Asaad Beshish, David M Kwiatkowski, Saul Flores, Sukumar Suguna Narashimhulu, Rohit Loomba, Christine A Capone, Francis Pike, John M Costello
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引用次数: 0

摘要

目的:报告先天性心脏病儿童气管切开术后疗效的多中心研究非常有限,尤其是单心室生理学患者。我们的目的是描述在丰坦手术前接受气管切开术的单心室生理学多中心队列患者的临床特征和预后:多中心回顾性队列研究:21家参与儿科心脏重症监护协会合作研究的三级儿科医疗机构:我们回顾了2010年1月至2020年12月期间,在21家参与儿科心脏重症监护协会合作研究的机构中,在Fontan手术前接受气管切开术的99名单心室生理学患儿,随访至2021年12月31日:干预措施:无:99例患者中有51例(52%)死亡。为确定气管切开术后死亡的相关因素,进行了 Cox 比例危险分析。结果以危险比(HR)和 95% CIs 表示。气管切开术的非呼吸指征(HR,2.21;95% CI,1.14-4.32)和气管切开术前接受机械通气的周数(HR,1.06;95% CI,1.02-1.11)与更高的死亡风险独立相关。相比之下,诊断出三尖瓣闭锁或埃布斯坦畸形与较低的死亡风险相关(HR,0.16;95% CI,0.04-0.69)。99名患者中有29名患者(29%)的治疗结果良好,即患者在等待丰坦手术期间存活或在心肺生理功能尚存活的情况下停止通气。气管切开术前机械通气的中位持续时间在顺利存活的患者中更短(6.1对12.1周;P<0.001),有神经系统适应症的16例气管切开术患者中只有1例顺利存活,有心脏适应症的10例气管切开术患者中只有0例顺利存活:单心室生理学儿童接受气管切开术的死亡风险很高,在讨论气管切开术作为这些儿童的一种选择时应仔细考虑。尽管要实现这一目标,必须对患者的选择和气管切开术的时机给予周到的关注,但良好的结果是可能的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Clinical Outcomes After Tracheostomy in Children With Single Ventricle Physiology: Collaborative Research From the Pediatric Cardiac Intensive Care Society Multicenter Cohort, 2010-2021.

Objectives: Multicenter studies reporting outcomes following tracheostomy in children with congenital heart disease are limited, particularly in patients with single ventricle physiology. We aimed to describe clinical characteristics and outcomes in a multicenter cohort of patients with single ventricle physiology who underwent tracheostomy before Fontan operation.

Design: Multicenter retrospective cohort study.

Setting: Twenty-one tertiary care pediatric institutions participating in the Collaborative Research from the Pediatric Cardiac Intensive Care Society.

Patients: We reviewed 99 children with single ventricle physiology who underwent tracheostomy before the Fontan operation at 21 institutions participating in Collaborative Research from the Pediatric Cardiac Intensive Care Society between January 2010 and December 2020, with follow-up through December 31, 2021.

Interventions: None.

Measurements and main results: Death occurred in 51 of 99 patients (52%). Cox proportional hazard analysis was performed to determine factors associated with death after tracheostomy. Results are presented as hazard ratio (HR) with 95% CIs. Nonrespiratory indication(s) for tracheostomy (HR, 2.21; 95% CI, 1.14-4.32) and number of weeks receiving mechanical ventilation before tracheostomy (HR, 1.06; 95% CI, 1.02-1.11) were independently associated with greater hazard of death. In contrast, diagnosis of tricuspid atresia or Ebstein's anomaly was associated with less hazard of death (HR, 0.16; 95% CI, 0.04-0.69). Favorable outcome, defined as survival to Fontan operation or decannulation while awaiting Fontan operation with viable cardiopulmonary physiology, occurred in 29 of 99 patients (29%). Median duration of mechanical ventilation before tracheostomy was shorter in patients who survived to favorable outcome (6.1 vs. 12.1 wk; p < 0.001), and only one of 16 patients with neurologic indications for tracheostomy and 0 of ten patients with cardiac indications for tracheostomy survived to favorable outcome.

Conclusions: For children with single ventricle physiology who undergo tracheostomy, mortality risk is high and should be carefully considered when discussing tracheostomy as an option for these children. Favorable outcomes are possible, although thoughtful attention to patient selection and tracheostomy timing are likely necessary to achieve this goal.

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来源期刊
Pediatric Critical Care Medicine
Pediatric Critical Care Medicine 医学-危重病医学
CiteScore
7.40
自引率
14.60%
发文量
991
审稿时长
3-8 weeks
期刊介绍: Pediatric Critical Care Medicine is written for the entire critical care team: pediatricians, neonatologists, respiratory therapists, nurses, and others who deal with pediatric patients who are critically ill or injured. International in scope, with editorial board members and contributors from around the world, the Journal includes a full range of scientific content, including clinical articles, scientific investigations, solicited reviews, and abstracts from pediatric critical care meetings. Additionally, the Journal includes abstracts of selected articles published in Chinese, French, Italian, Japanese, Portuguese, and Spanish translations - making news of advances in the field available to pediatric and neonatal intensive care practitioners worldwide.
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