早产儿加温湿化高流量经鼻导管通气初始呼吸支持失败的危险因素分析

doi:10.7499/j.issn.1008-8830.2107017

Abstract
Figure/Table
References(28)
Related Citation (15)
Read Tracking
Download Tracking

Download: PDF (752 KB) HTML
Export: BibTeX | EndNote (RIS) Supporting Info

Abstract Objective To study the risk factors for treatment failure of heated humidified high-flow nasal cannula (HHHFNC) as initial respiratory support for preterm infants. Methods A retrospective analysis was performed on the medical data of the preterm infants who were admitted from January 2018 to April 2021 and received HHHFNC for initial respiratory support after birth. According to whether it was necessary to upgrade to noninvasive continuous positive airway pressure or invasive mechanical ventilation within 72 hours after treatment, they were divided into a failure group and a success group. Univariate and multivariate logistic regression analyses were used to determine the risk factors for failure of HHHFNC as initial respiratory support. Results A total of 166 preterm infants were included, among whom 48 (28.9%) experienced the treatment failure of HHHNFC as initial respiratory support. The univariate analysis showed that compared with the success group with 118 infants, the failure group had significantly lower gestational age and birth weight and a significantly higher proportion of infants with fraction of inspired oxygen >35%, flow rate >6 L/minute, patent ductus arteriosus (PDA), respiratory distress syndrome (RDS), or use of pulmonary surfactant (P<0.05). The multivariate logistic regression analysis showed that gestational age <32 weeks, PDA (>1.5 mm and left atrium/aorta diameter ratio >1.4), fraction of inspired oxygen >35%, flow rate >6 L/minute, and presence of RDS were risk factors for the treatment failure of HHHNFC as initial respiratory support (P<0.05). Conclusions The preterm infants with a gestational age of <32 weeks or the presence of RDS tend to have a high risk of failure of HHHNFC as initial respiratory support. The risk of failure of HHHFNC as initial respiratory support increases in infants with oxygen concentration >35% and/or flow rate >6 L/minute, or the presence of PDA, suggesting an upgrade of respiratory support should be considered. Citation:

	Service

	E-mail this article
	Add to my bookshelf
	Add to citation manager
	E-mail Alert
	RSS
	Articles by authors
	DU Zuo-Ping
	XIAO Chuan-Xu
	ZENG Yi-Xie
	CHEN Kai

Key words： Heated humidified high-flow nasal cannula Risk factor Preterm infant

Received: 05 July 2021

Cite this article:

DU Zuo-Ping,XIAO Chuan-Xu,ZENG Yi-Xie et al. Risk factors for treatment failure of heated humidified high-flow nasal cannula as initial respiratory support for preterm infants[J]. CJCP, 2021, 23(9): 896-902.

URL:

http://www.zgddek.com/EN/10.7499/j.issn.1008-8830.2107017 OR http://www.zgddek.com/EN/Y2021/V23/I9/896

	1 石英杰, 湛永乐, 陈云利, 等. 早产影响因素的前瞻性队列研究[J]. 中华疾病控制杂志, 2021, 25(2): 143-148. DOI: 10.16462/j.cnki.zhjbkz.2021.02.005.
	2 邵肖梅, 叶鸿瑁, 丘小汕. 实用新生儿学[M]. 4版. 北京: 人民卫生出版社, 2011.
	Lodeserto FJ, Lettich TM, Rezaie SR. High-flow nasal cannula: mechanisms of action and adult and pediatric indications[J]. Cureus, 2018, 10(11): e3639. PMID: 30740281. PMCID: PMC6358040. DOI: 10.7759/cureus.3639.
	Coletti KD, Bagdure DN, Walker LK, et al. High-flow nasal cannula utilization in pediatric critical care[J]. Respir Care, 2017, 62(8): 1023-1029. PMID: 28588119. DOI: 10.4187/respcare.05153.
	Dysart K, Miller TL, Wolfson MR, et al. Research in high flow therapy: mechanisms of action[J]. Respir Med, 2009, 103(10): 1400-1405. PMID: 19467849. DOI: 10.1016/j.rmed.2009.04.007.
	王柱, 向建文, 高薇薇, 等. 两种无创呼吸支持治疗极低出生体重儿呼吸窘迫综合征疗效分析[J]. 中国当代儿科杂志, 2018, 20(8): 603-607. PMID: 30111466. PMCID: PMC7389755. DOI: 10.7499/j.issn.1008-8830.2018.08.001.
	7 封志纯, 钟梅. 实用早产与早产儿学[M]. 北京: 军事医学科学出版社, 2010: 134-140.
	Sweet DG, Carnielli V, Greisen G, et al. European consensus guidelines on the management of respiratory distress syndrome—2016 update[J]. Neonatology, 2017, 111(2): 107-125. PMID: 27649091. DOI: 10.1159/000448985.
	Kinsella JP, Greenough A, Abman SH. Bronchopulmonary dysplasia[J]. Lancet, 2006, 367(9520): 1421-1431. PMID: 16650652. DOI: 10.1016/S0140-6736(06)68615-7.
	Garg BD, Bajaj N, Sharma D. To compare the efficacy of heated humidified high-flow nasal cannula and continuous positive airway pressure in post-extubation period in VLBW infants[J]. J Trop Pediatr, 2018, 64(4): 262-266. PMID: 28977653. DOI: 10.1093/tropej/fmx057.
	Chen J, Lin YY, Du LL, et al. The comparison of HHHFNC and NCPAP in extremely low-birth-weight preterm infants after extubation: a single-center randomized controlled trial[J]. Front Pediatr, 2020, 8: 250. PMID: 32670991. PMCID: PMC7332541. DOI: 10.3389/fped.2020.00250.
	Soonsawad S, Swatesutipun B, Limrungsikul A, et al. Heated humidified high-flow nasal cannula for prevention of extubation failure in preterm infants[J]. Indian J Pediatr, 2017, 84(4): 262-266. PMID: 28054235. DOI: 10.1007/s12098-016-2280-2.
	康文清, 许邦礼, 刘大鹏, 等. 加温湿化高流量鼻导管吸氧在32周以下早产儿撤机中的疗效比较[J]. 中国当代儿科杂志, 2016, 18(6): 488-491. PMID: 27324534. PMCID: PMC7389091. DOI: 10.7499/j.issn.1008-8830.2016.06.004.
	Hegde D, Mondkar J, Panchal H, et al. Heated humidified high flow nasal cannula versus nasal continuous positive airway pressure as primary mode of respiratory support for respiratory distress in preterm infants[J]. Indian Pediatr, 2016, 53(2): 129-133. PMID: 26897144. DOI: 10.1007/s13312-016-0806-3.
	Akbarian-Rad Z, Mohammadi A, Khafri S, et al. Comparison of heated humidified high flow nasal cannula and nasal continuous positive airway pressure after surfactant administration in preterm neonates with respiratory distress syndrome[J]. Clin Respir J, 2020, 14(8): 740-747. PMID: 32483928. DOI: 10.1111/crj.13191.
	Armanian AM, Iranpour R, Parvaneh M, et al. Heated humidified high flow nasal cannula (HHHFNC) is not an effective method for initial treatment of respiratory distress syndrome (RDS) versus nasal intermittent mandatory ventilation (NIMV) and nasal continuous positive airway pressure (NCPAP)[J]. J Res Med Sci, 2019, 24: 73. PMID: 31523259. PMCID: PMC6734667. DOI: 10.4103/jrms.JRMS_2_19.
	Shin J, Park K, Lee EH, et al. Humidified high flow nasal cannula versus nasal continuous positive airway pressure as an initial respiratory support in preterm infants with respiratory distress: a randomized, controlled non-inferiority trial[J]. J Korean Med Sci, 2017, 32(4): 650-655.PMID: 28244292. PMCID: PMC5334164. DOI: 10.3346/jkms.2017.32.4.650.
	Kubicka ZJ, Limauro J, Darnall RA. Heated, humidified high-flow nasal cannula therapy: yet another way to deliver continuous positive airway pressure?[J]. Pediatrics, 2008, 121(1): 82-88. PMID: 18166560. DOI: 10.1542/peds.2007-0957.
	Roberts CT, Owen LS, Manley BJ, et al. Nasal high-flow therapy for primary respiratory support in preterm infants[J]. N Engl J Med, 2016, 375(12): 1142-1151. PMID: 27653564. DOI: 10.1056/NEJMoa1603694.
	Lee WY, Choi EK, Shin J, et al. Risk factors for treatment failure of heated humidified high-flow nasal cannula as an initial respiratory support in newborn infants with respiratory distress[J]. Pediatr Neonatol, 2020, 61(2): 174-179. PMID: 31628028. DOI: 10.1016/j.pedneo.2019.09.004.
	Rubarth LB, Quinn J. Respiratory development and respiratory distress syndrome[J]. Neonatal Netw, 2015, 34(4): 231-238. PMID: 26802638. DOI: 10.1891/0730-0832.34.4.231.
	Sherman TI, Blackson T, Touch SM, et al. Physiologic effects of CPAP: application and monitoring[J]. Neonatal Netw, 2003, 22(6): 7-16. PMID: 14700177. DOI: 10.1891/0730-0832.22.6.7.
	中华医学会儿科学分会新生儿学组. 早产儿无创呼吸支持临床应用建议[J]. 中华儿科杂志, 2018, 56(9): 643-647. PMID: 30180400. DOI: 10.3760/cma.j.issn.0578-1310.2018.09.002.
	Prescott S, Keim-Malpass J. Patent ductus arteriosus in the preterm infant: diagnostic and treatment options[J]. Adv Neonatal Care, 2017, 17(1): 10-18. PMID: 27740976. DOI: 10.1097/ANC.0000000000000340.
	Clyman RI, Couto J, Murphy GM. Patent ductus arteriosus: are current neonatal treatment options better or worse than no treatment at all?[J]. Semin Perinatol, 2012, 36(2): 123-129. PMID: 22414883. PMCID: PMC3305915. DOI: 10.1053/j.semperi.2011.09.022.
	Ohlsson A, Shah SS. Ibuprofen for the prevention of patent ductus arteriosus in preterm and/or low birth weight infants[J]. Cochrane Database Syst Rev, 2011(7): CD004213. PMID: 21735396. DOI: 10.1002/14651858.CD004213.pub3.
	Bancalari E, Claure N, Gonzalez A. Patent ductus arteriosus and respiratory outcome in premature infants[J]. Biol Neonate, 2005, 88(3): 192-201. PMID: 16210841. DOI: 10.1159/000087582.
	Lavizzari A, Veneroni C, Colnaghi M, et al. Respiratory mechanics during NCPAP and HHHFNC at equal distending pressures[J]. Arch Dis Child Fetal Neonatal Ed, 2014, 99(4): F315-F320. PMID: 24786469. DOI: 10.1136/archdischild-2013-305855.