Salar S Badruddin, Jason A Clayton, Bryan P McKee, Katherine N Slain, Alexandre T Rotta, Sindhoosha Malay, Steven L Shein
{"title":"毛细支气管炎拔管后24小时内重新插管的患病率:使用虚拟儿科系统数据库的回顾性队列研究。","authors":"Salar S Badruddin, Jason A Clayton, Bryan P McKee, Katherine N Slain, Alexandre T Rotta, Sindhoosha Malay, Steven L Shein","doi":"10.1097/PCC.0000000000002581","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>High-flow nasal cannula and noninvasive positive pressure ventilation are used to support children following liberation from invasive mechanical ventilation. Evidence comparing extubation failure rates between patients randomized to high-flow nasal cannula and noninvasive positive pressure ventilation is available for adult and neonatal patients; however, similar pediatric trials are lacking. In this study, we employed a quality controlled, multicenter PICU database to test the hypothesis that high-flow nasal cannula is associated with higher prevalence of reintubation within 24 hours among patients with bronchiolitis.</p><p><strong>Design: </strong>Secondary analysis of a prior study utilizing the Virtual Pediatric Systems database.</p><p><strong>Setting: </strong>One-hundred twenty-four participating PICUs.</p><p><strong>Patients: </strong>Children less than 24 months old with a primary diagnosis of bronchiolitis who were admitted to one of 124 PICUs between January 2009 and September 2015 and received invasive mechanical ventilation.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Among 759 patients, median age was 2.4 months (1.3-5.4 mo), 41.2% were female, 39.7% had greater than or equal to 1 comorbid condition, and 43.7% were Caucasian. Median PICU length of stay was 8.7 days (interquartile range, 5.8-13.7 d) and survival to PICU discharge was 100%. Median duration of intubation was 5.5 days (3.4-9.0 d) prior to initial extubation. High-flow nasal cannula was used following extubation in most (656 [86.5%]) analyzed subjects. The overall prevalence of reintubation within 24 hours was 5.9% (45 children). Extubation to noninvasive positive pressure ventilation was associated with greater prevalence of reintubation than extubation to high-flow nasal cannula (11.7% vs 5.0%; p = 0.016) and, in an a posteriori model that included Pediatric Index of Mortality 2 score and comorbidities, was associated with increased odds of reintubation (odds ratio, 2.43; 1.11-5.34; p = 0.027).</p><p><strong>Conclusions: </strong>In this secondary analysis of a multicenter database of children with bronchiolitis, extubation to high-flow nasal cannula was associated with a lower prevalence of reintubation within 24 hours compared with noninvasive positive pressure ventilation in both unmatched and propensity-matched analysis. Prospective trials are needed to determine if post-extubation support modality can mitigate the risk of extubation failure.</p>","PeriodicalId":520744,"journal":{"name":"Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies","volume":" ","pages":"474-482"},"PeriodicalIF":0.0000,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"7","resultStr":"{\"title\":\"Prevalence of Reintubation Within 24 Hours of Extubation in Bronchiolitis: Retrospective Cohort Study Using the Virtual Pediatric Systems Database.\",\"authors\":\"Salar S Badruddin, Jason A Clayton, Bryan P McKee, Katherine N Slain, Alexandre T Rotta, Sindhoosha Malay, Steven L Shein\",\"doi\":\"10.1097/PCC.0000000000002581\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>High-flow nasal cannula and noninvasive positive pressure ventilation are used to support children following liberation from invasive mechanical ventilation. Evidence comparing extubation failure rates between patients randomized to high-flow nasal cannula and noninvasive positive pressure ventilation is available for adult and neonatal patients; however, similar pediatric trials are lacking. In this study, we employed a quality controlled, multicenter PICU database to test the hypothesis that high-flow nasal cannula is associated with higher prevalence of reintubation within 24 hours among patients with bronchiolitis.</p><p><strong>Design: </strong>Secondary analysis of a prior study utilizing the Virtual Pediatric Systems database.</p><p><strong>Setting: </strong>One-hundred twenty-four participating PICUs.</p><p><strong>Patients: </strong>Children less than 24 months old with a primary diagnosis of bronchiolitis who were admitted to one of 124 PICUs between January 2009 and September 2015 and received invasive mechanical ventilation.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>Among 759 patients, median age was 2.4 months (1.3-5.4 mo), 41.2% were female, 39.7% had greater than or equal to 1 comorbid condition, and 43.7% were Caucasian. Median PICU length of stay was 8.7 days (interquartile range, 5.8-13.7 d) and survival to PICU discharge was 100%. Median duration of intubation was 5.5 days (3.4-9.0 d) prior to initial extubation. High-flow nasal cannula was used following extubation in most (656 [86.5%]) analyzed subjects. The overall prevalence of reintubation within 24 hours was 5.9% (45 children). Extubation to noninvasive positive pressure ventilation was associated with greater prevalence of reintubation than extubation to high-flow nasal cannula (11.7% vs 5.0%; p = 0.016) and, in an a posteriori model that included Pediatric Index of Mortality 2 score and comorbidities, was associated with increased odds of reintubation (odds ratio, 2.43; 1.11-5.34; p = 0.027).</p><p><strong>Conclusions: </strong>In this secondary analysis of a multicenter database of children with bronchiolitis, extubation to high-flow nasal cannula was associated with a lower prevalence of reintubation within 24 hours compared with noninvasive positive pressure ventilation in both unmatched and propensity-matched analysis. Prospective trials are needed to determine if post-extubation support modality can mitigate the risk of extubation failure.</p>\",\"PeriodicalId\":520744,\"journal\":{\"name\":\"Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies\",\"volume\":\" \",\"pages\":\"474-482\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2021-05-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"7\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/PCC.0000000000002581\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/PCC.0000000000002581","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 7
摘要
目的:应用高流量鼻插管和无创正压通气来支持脱离有创机械通气的儿童。比较随机选择高流量鼻插管和无创正压通气患者拔管失败率的证据可用于成人和新生儿患者;然而,缺乏类似的儿科试验。在这项研究中,我们采用了一个质量控制的多中心PICU数据库来验证高流量鼻插管与毛细支气管炎患者24小时内更高的再插管患病率相关的假设。设计:利用虚拟儿科系统数据库对先前研究进行二次分析。设置:124个参与picu。患者:在2009年1月至2015年9月期间入住124个picu之一,初步诊断为毛细支气管炎的小于24个月的儿童,接受有创机械通气。干预措施:没有。测量结果和主要结果:759例患者中位年龄为2.4个月(1.3-5.4个月),41.2%为女性,39.7%为大于或等于1种合并症,43.7%为白种人。PICU的中位住院时间为8.7天(四分位数间距为5.8-13.7天),到PICU出院的存活率为100%。首次拔管前插管的中位持续时间为5.5天(3.4-9.0 d)。大多数(656例[86.5%])分析对象拔管后使用高流量鼻插管。24小时内再插管的总体患病率为5.9%(45名儿童)。拔管进行无创正压通气与拔管进行高流量鼻插管相比,再次插管的患病率更高(11.7% vs 5.0%;p = 0.016),并且在包含儿科死亡率指数2评分和合并症的后验模型中,与再次插管的几率增加相关(优势比,2.43;1.11 - -5.34;P = 0.027)。结论:在对毛细支气管炎儿童多中心数据库的二次分析中,在不匹配和倾向匹配的分析中,与无创正压通气相比,拔管至高流量鼻插管与24小时内再插管的患病率较低相关。需要前瞻性试验来确定拔管后支持模式是否可以减轻拔管失败的风险。
Prevalence of Reintubation Within 24 Hours of Extubation in Bronchiolitis: Retrospective Cohort Study Using the Virtual Pediatric Systems Database.
Objectives: High-flow nasal cannula and noninvasive positive pressure ventilation are used to support children following liberation from invasive mechanical ventilation. Evidence comparing extubation failure rates between patients randomized to high-flow nasal cannula and noninvasive positive pressure ventilation is available for adult and neonatal patients; however, similar pediatric trials are lacking. In this study, we employed a quality controlled, multicenter PICU database to test the hypothesis that high-flow nasal cannula is associated with higher prevalence of reintubation within 24 hours among patients with bronchiolitis.
Design: Secondary analysis of a prior study utilizing the Virtual Pediatric Systems database.
Patients: Children less than 24 months old with a primary diagnosis of bronchiolitis who were admitted to one of 124 PICUs between January 2009 and September 2015 and received invasive mechanical ventilation.
Interventions: None.
Measurements and main results: Among 759 patients, median age was 2.4 months (1.3-5.4 mo), 41.2% were female, 39.7% had greater than or equal to 1 comorbid condition, and 43.7% were Caucasian. Median PICU length of stay was 8.7 days (interquartile range, 5.8-13.7 d) and survival to PICU discharge was 100%. Median duration of intubation was 5.5 days (3.4-9.0 d) prior to initial extubation. High-flow nasal cannula was used following extubation in most (656 [86.5%]) analyzed subjects. The overall prevalence of reintubation within 24 hours was 5.9% (45 children). Extubation to noninvasive positive pressure ventilation was associated with greater prevalence of reintubation than extubation to high-flow nasal cannula (11.7% vs 5.0%; p = 0.016) and, in an a posteriori model that included Pediatric Index of Mortality 2 score and comorbidities, was associated with increased odds of reintubation (odds ratio, 2.43; 1.11-5.34; p = 0.027).
Conclusions: In this secondary analysis of a multicenter database of children with bronchiolitis, extubation to high-flow nasal cannula was associated with a lower prevalence of reintubation within 24 hours compared with noninvasive positive pressure ventilation in both unmatched and propensity-matched analysis. Prospective trials are needed to determine if post-extubation support modality can mitigate the risk of extubation failure.