First-Line Respiratory Support for Children With Hematologic Malignancy and Acute Respiratory Failure.

Autor:	Asif H; Pritzker School of Medicine, University of Chicago, Chicago, IL., McNeer JL; Department of Pediatrics, Section of Pediatric Hematology/Oncology, University of Utah, Primary Children's Hospital, Salt Lake City, UT., Ghanayem NS; Department of Pediatrics, Section of Pediatric Critical Care Medicine, University of Chicago, Comer Children's Hospital, Chicago, IL., Cursio JF; Department of Public Health Sciences, University of Chicago, Chicago, IL., Kane JM; Department of Pediatrics, Section of Pediatric Critical Care Medicine, University of Chicago, Comer Children's Hospital, Chicago, IL.
Jazyk:	angličtina
Zdroj:	Critical care explorations [Crit Care Explor] 2024 Apr 09; Vol. 6 (4), pp. e1076. Date of Electronic Publication: 2024 Apr 09 (Print Publication: 2024).
DOI:	10.1097/CCE.0000000000001076
Abstrakt:	Objectives: To characterize trends in noninvasive ventilation (NIV) and invasive mechanical ventilation (IMV) use over time in children with hematologic malignancy admitted to the PICU with acute respiratory failure (ARF), and to identify risk factors associated with NIV failure requiring transition to IMV. Design: Retrospective cohort analysis using the Virtual Pediatric Systems (VPS, LLC) between January 1, 2010 and December 31, 2019. Setting: One hundred thirteen North American PICUs participating in VPS. Patients: Two thousand four hundred eighty children 0-21 years old with hematologic malignancy admitted to participating PICUs for ARF requiring respiratory support. Interventions: None. Measurements and Main Results: There were 3013 total encounters, of which 868 (28.8%) received first-line NIV alone (NIV only), 1544 (51.2%) received first-line IMV (IMV only), and 601 (19.9%) required IMV after a failed NIV trial (NIV failure). From 2010 to 2019, the NIV only group increased from 9.6% to 43.1% and the IMV only group decreased from 80.1% to 34.2% ( p < 0.001). The NIV failure group had the highest mortality compared with NIV only and IMV only (36.6% vs. 8.1%, vs. 30.5%, p < 0.001). However, risk-of-mortality (ROM) was highest in the IMV only group compared with NIV only and NIV failure (median Pediatric Risk of Mortality III ROM 8.1% vs. 2.8% vs. 5.5%, p < 0.001). NIV failure patients also had the longest median PICU length of stay compared with the other two study groups (15.2 d vs. 6.1 and 9.0 d, p < 0.001). Higher age was associated with significantly decreased odds of NIV failure, and diagnosis of non-Hodgkin lymphoma was associated with significantly increased odds of NIV failure compared with acute lymphoid leukemia. Conclusions: For children with hematologic malignancy admitted to the PICU with ARF, NIV has replaced IMV as the most common initial therapy. NIV failure rate remains high with high-observed mortality despite lower PICU admission ROM. Competing Interests: Mr. Asif is a recipient of the National Institutes of Health NCI-SOAR (grant 25CA240134), and received support from the Scholarship and Discovery Program at the Pritzker School of Medicine. Dr. Kane received funding support from the Portes Foundation. The remaining authors have no conflicts of interest or sources of funding to declare. (Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.)
Databáze:	MEDLINE
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