Objective To investigate the differences in clinical characteristics among children on prolonged mechanical ventilation (PMV) due to different primary diseases. Methods A retrospective analysis was performed on the clinical data of 59 pediatric patients requiring PMV from July 2017 to September 2022. According to the primary disease, they were divided into respiratory disease (RD) group, central nervous system (CNS) group, neuromuscular disease (NMD) group, and other disease group. The four groups were compared in terms of general information, treatment, and outcome. Results There were significant differences among the four groups in age, body weight, Pediatric Logistic Organ Dysfunction-2 (PELOD-2) score, Pediatric Risk of Mortality III (PRISM Ⅲ) score, analgesic and sedative treatment, nutrition supply, rehabilitation treatment, tracheotomy, successful ventilator weaning, and outcomes ( P<0.05). Compared with the RD group, the CNS group and the other disease group had a significantly higher age and a significantly higher proportion of children receiving rehabilitation treatment, and the CNS group had a significantly higher proportion of children receiving tracheotomy ( P<0.008). Compared with the other disease group, the CNS group and the NMD group had significantly lower PELOD-2 and PRISM III scores, and the CNS group had a significantly higher proportion of children with successful ventilator weaning and a significantly higher proportion of children who were improved and discharged ( P<0.008). Conclusions There are differences in clinical characteristics among children receiving PMV due to different etiologies. Most children in the RD group have a younger age, and children in the CNS group have a relatively good prognosis.
Key words
Prolonged mechanical ventilation /
Etiology /
Critical illness /
Child
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
References
1 Sch?nhofer B, Geiseler J, Dellweg D, et al . Prolonged weaning: S2k guideline published by the German Respiratory Society[J]. Respiration, 2021, 99( 11): 982- 1084. PMID: 33302267. DOI: 10.1159/000510085 .
2 Pavone M, Verrillo E, Onofri A, et al . Characteristics and outcomes in children on long-term mechanical ventilation: the experience of a pediatric tertiary center in Rome[J]. Ital J Pediatr, 2020, 46( 1): 12. PMID: 32005269. PMCID: PMC6995086. DOI: 10.1186/s13052-020-0778-8 .
3 Chau SK, Yung AW, Lee SL . Long-term management for ventilator-assisted children in Hong Kong: 2 decades' experience[J]. Respir Care, 2017, 62( 1): 54- 64. PMID: 27899532. DOI: 10.4187/respcare.04989 .
4 Barker N, Sinha A, Jesson C, et al . Changes in UK paediatric long-term ventilation practice over 10 years[J]. Arch Dis Child, 2023, 108( 3): 218- 224. PMID: 36446480. DOI: 10.1136/archdischild-2021-323562 .
5 陈伟明, 张铮铮, 陆国平 . 儿童长期机械通气的概念及国内外现状[J]. 中国小儿急救医学, 2022, 29( 3): 161- 164. DOI: 10.3760/cma.j.issn.1673-4912.2022.03.001 .
6 Zhang Z, Tao J, Cai X, et al . Clinical characteristics and outcomes of children with prolonged mechanical ventilation in PICUs in mainland China: a national survey[J]. Pediatr Pulmonol, 2023, 58( 5): 1401- 1410. PMID: 36705329. DOI: 10.1002/ppul.26332 .
7 Nathan AM, Loo HY, de Bruyne JA, et al . Thirteen years of invasive and noninvasive home ventilation for children in a developing country: a retrospective study[J]. Pediatr Pulmonol, 2017, 52( 4): 500- 507. PMID: 27712049. DOI: 10.1002/ppul.23569 .
8 刘盼, 张铮铮, 张羿, 等 . 儿童重症监护病房医护人员对长期机械通气认知及管理现况的多中心调查[J]. 中国小儿急救医学, 2022, 29( 5): 347- 352. DOI: 10.3760/cma.j.issn.1673-4912.2022.05.006 .
9 Sauthier M, Rose L, Jouvet P . Pediatric prolonged mechanical ventilation: considerations for definitional criteria[J]. Respir Care, 2017, 62( 1): 49- 53. PMID: 27879381. DOI: 10.4187/respcare.04881 .
10 Mehta NM, Skillman HE, Irving SY, et al . Guidelines for the provision and assessment of nutrition support therapy in the pediatric critically ill patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition[J]. Pediatr Crit Care Med, 2017, 18( 7): 675- 715. PMID: 28691958. DOI: 10.1097/PCC.0000000000001134 .
11 Dokken M, Rust?en T, Stubhaug A . Indirect calorimetry reveals that better monitoring of nutrition therapy in pediatric intensive care is needed[J]. JPEN J Parenter Enteral Nutr, 2015, 39( 3): 344- 352. PMID: 24255088. DOI: 10.1177/0148607113511990 .
12 刘刚, 刘双林, 王美菊, 等 . 机械通气困难撤机/延迟撤机的病理生理学因素与解决策略[J]. 中国临床新医学, 2021, 14( 4): 329- 332. DOI: 10.3969/j.issn.1674-3806.2021.04.01 .
13 Silva IS, Pedrosa R, Azevedo IG, et al . Respiratory muscle training in children and adults with neuromuscular disease[J]. Cochrane Database Syst Rev, 2019, 9( 9): CD011711. PMID: 31487757. PMCID: PMC6953358. DOI: 10.1002/14651858.CD011711.pub2 .
14 Koltsida G, Konstantinopoulou S . Long term outcomes in chronic lung disease requiring tracheostomy and chronic mechanical ventilation[J]. Semin Fetal Neonatal Med, 2019, 24( 5): 101044. PMID: 31706921. DOI: 10.1016/j.siny.2019.101044 .
15 中华医学会儿科学分会呼吸学组, 中国医师协会呼吸医师分会儿科呼吸工作委员会, 中国医药教育协会儿科专业委员会, 等 . 儿童闭塞性细支气管炎的诊断和治疗专家共识（2023）[J]. 中华儿科杂志, 2023, 61( 9): 786- 793. PMID: 37650159. DOI: 10.3760/cma.j.cn112140-20230301-00146 .
16 Tortuyaux R, Davion JB, Jourdain M . Intensive care unit-acquired weakness: questions the clinician should ask[J]. Rev Neurol (Paris), 2022, 178( 1-2): 84- 92. PMID: 34998522. DOI: 10.1016/j.neurol.2021.12.007 .
17 危重症儿童营养评估及支持治疗指南（中国）工作组, 钱素云, 陆国平, 等 . 危重症儿童营养评估及支持治疗指南（2018, 中国, 标准版）[J]. 中国循证儿科杂志, 2018, 13( 1): 1- 29. DOI: 10.3969/j.issn.1673-5501.2018.01.001 .
18 Li XJ, You XY, Wang CY, et al . Bidirectional brain-gut-microbiota axis in increased intestinal permeability induced by central nervous system injury[J]. CNS Neurosci Ther, 2020, 26( 8): 783- 790. PMID: 32472633. PMCID: PMC7366750. DOI: 10.1111/cns.13401 .
19 Hov B, Andersen T, Toussaint M, et al . User-perceived impact of long-term mechanical assisted cough in paediatric neurodisability[J]. Dev Med Child Neurol, 2023, 65( 5): 655- 663. PMID: 36787316. DOI: 10.1111/dmcn.15543 .
20 刘艳玲 . PICU延长机械通气患儿的特征和危险因素: 一项前瞻性单中心研究[D]. 重庆: 重庆医科大学, 2022.
21 Tanaka A, Uchiyama A, Kitamura T, et al . Association between early tracheostomy and patient outcomes in critically ill patients on mechanical ventilation: a multicenter cohort study[J]. J Intensive Care, 2022, 10( 1): 19. PMID: 35410403. PMCID: PMC8996211. DOI: 10.1186/s40560-022-00610-x .
22 Karamyshau AM, Leonau AV, Shcharbakova PA, et al . Tracheostomy as a component of intensive care for central nervous system diseases[J]. Health and Ecol Issues, 2023, 19( 4): 35- 41. DOI: 10.51523/2708-6011.2022-19-4-05 .
23 徐珊珊, 张琳琳, 周建新 . 神经重症患者脱机拔管研究进展[J]. 中华危重病急救医学, 2022, 34( 9): 1004- 1008. PMID: 36377460. DOI: 10.3760/cma.j.cn121430-20220317-00257 .
PDF(571 KB)
