Nasal high flow therapy introduction lowers reintubation risk in a Peruvian paediatric intensive care unit.

Autor: Nielsen KR; Department of Pediatrics, Critical Care Medicine, University of Washington, Seattle, Washington.; Department of Global Health, University of Washington, Seattle, Washington., Becerra MR; Departamento de Cuidados Intensivos, Instituto Nacional de Salud del Niño, Lima, Peru., Mallma G; Departamento de Cuidados Intensivos, Instituto Nacional de Salud del Niño, Lima, Peru., Ellington LE; Graduate Medical Education, University of Washington, Seattle, Washington., Onchiri F; Seattle Children's Core for Biomedical Statistics, Seattle Children's Research Institute, Seattle, Washington., Roberts JS; Department of Pediatrics, Critical Care Medicine, University of Washington, Seattle, Washington., Zunt J; Department of Global Health, University of Washington, Seattle, Washington.; Department of Neurology, University of Washington, Seattle, Washington., Tantaleán da Fieno J; Departamento de Cuidados Intensivos, Instituto Nacional de Salud del Niño, Lima, Peru.; Universidad Nacional Federico Villarreal, Lima, Peru.
Jazyk: angličtina
Zdroj: Acta paediatrica (Oslo, Norway : 1992) [Acta Paediatr] 2020 Dec; Vol. 109 (12), pp. 2748-2754. Date of Electronic Publication: 2020 Apr 17.
DOI: 10.1111/apa.15265
Abstrakt: Aim: We examined the impact of introducing high-flow nasal oxygen therapy (HFNT) on children under five with post-extubation respiratory failure in a paediatric intensive care unit (PICU) in Peru.
Methods: This quasi-experimental study compared clinical outcomes before and after initial HFNT deployment in the PICU at Instituto Nacional de Salud del Niño in Lima in June 2016. We compared three groups: 29 received post-extubation HFNT and 17 received continuous positive airway pressure (CPAP) from 2016-17 and 12 historical controls received CPAP from 2012-16. The primary outcome was the need for mechanical ventilation. Adjusted hazard ratios (aHR) and 95% confidence intervals (95% CI) were calculated via survival analysis.
Results: High-flow nasal oxygen therapy and CPAP did not alter the need for mechanical ventilation after extubation (aHR 0.47, 95% CI 0.15-1.48 and 0.96, 95% CI 0.35-2.62, respectively) but did reduce the risk of reintubation (aHR 0.18, 95% CI 0.06-0.57 and 0.14, 95% CI 0.03-0.72, respectively). PICU length of stay was 11, 18 and 37 days for CPAP, HFNT and historical CPAP and mortality was 12%, 7% and 27%, respectively. There was no effect on the duration of sedative infusions.
Conclusion: High-flow nasal oxygen therapy provided effective support for some children, but larger studies in resource-constrained settings are needed.
(© 2020 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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