Noninvasive Positive Pressure Ventilation Use and In-Hospital Cardiac Arrest in Bronchiolitis.

Q4 Medicine Critical care explorations Pub Date : 2024-05-15 eCollection Date: 2024-05-01 DOI:10.1097/CCE.0000000000001088
Lindsay N Shepard, Sanjiv Mehta, Kathryn Graham, Martha Kienzle, Amanda O'Halloran, Nadir Yehya, Ryan W Morgan, Garrett P Keim
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Abstract

Importance: A recent study showed an association between high hospital-level noninvasive positive pressure ventilation (NIPPV) use and in-hospital cardiac arrest (IHCA) in children with bronchiolitis.

Objectives: We aimed to determine if patient-level exposure to NIPPV in children with bronchiolitis was associated with IHCA.

Design, setting and participants: Retrospective cohort study at a single-center quaternary PICU in North America including children with International Classification of Diseases primary or secondary diagnoses of bronchiolitis in the Virtual Pediatric Systems database.

Main outcomes and measures: The primary exposure was NIPPV and the primary outcome was IHCA.

Measurements and main results: Of 4698 eligible ICU admissions with bronchiolitis diagnoses, IHCA occurred in 1.2% (57/4698). At IHCA onset, invasive mechanical ventilation (IMV) was the most frequent level of respiratory support (65%, 37/57), with 12% (7/57) receiving NIPPV. Patients with IHCA had higher Pediatric Risk of Mortality-III scores (3 [0-8] vs. 0 [0-2]; p < 0.001), more frequently had a complex chronic condition (94.7% vs. 46.2%; p < 0.001), and had higher mortality (21.1% vs. 1.0%; p < 0.001) compared with patients without IHCA. Return of spontaneous circulation (ROSC) was achieved in 93% (53/57) of IHCAs; 79% (45/57) survived to hospital discharge. All seven children without chronic medical conditions and with active bronchiolitis symptoms at the time of IHCA achieved ROSC, and 86% (6/7) survived to discharge. In multivariable analysis restricted to patients receiving NIPPV or IMV, NIPPV exposure was associated with lower odds of IHCA (adjusted odds ratio [aOR], 0.07; 95% CI, 0.03-0.18) compared with IMV. In secondary analysis evaluating categorical respiratory support in all patients, compared with IMV, NIPPV was associated with lower odds of IHCA (aOR, 0.35; 95% CI, 0.14-0.87), whereas no difference was found for minimal respiratory support (none/nasal cannula/humidified high-flow nasal cannula [aOR, 0.56; 95% CI, 0.23-1.36]).

Conclusions and relevance: Cardiac arrest in children with bronchiolitis is uncommon, occurring in 1.2% of bronchiolitis ICU admissions. NIPPV use in children with bronchiolitis was associated with lower odds of IHCA.

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支气管炎患者使用无创正压通气与院内心脏骤停。
重要性:最近的一项研究表明,在患有支气管炎的儿童中,医院层面大量使用无创正压通气(NIPPV)与院内心脏骤停(IHCA)之间存在关联:我们旨在确定支气管炎患儿在患者层面接触无创正压通气是否与 IHCA 相关:在北美一家单中心四级 PICU 进行的回顾性队列研究,包括虚拟儿科系统数据库中国际疾病分类一级或二级诊断为支气管炎的儿童:主要暴露是NIPPV,主要结果是IHCA:在符合条件的 4698 例诊断为支气管炎的 ICU 入院患者中,1.2%(57/4698)发生了 IHCA。IHCA发生时,有创机械通气(IMV)是最常用的呼吸支持方式(65%,37/57),12%(7/57)接受NIPPV。与无 IHCA 的患者相比,IHCA 患者的儿科死亡风险-III 评分更高(3 [0-8] vs. 0 [0-2]; p < 0.001),患有复杂慢性疾病的比例更高(94.7% vs. 46.2%; p < 0.001),死亡率更高(21.1% vs. 1.0%; p < 0.001)。93%(53/57)的IHCA患者实现了自主循环(ROSC)恢复;79%(45/57)的患者存活至出院。七名无慢性疾病且在 IHCA 时有活动性支气管炎症状的患儿全部实现了 ROSC,86%(6/7)的患儿存活至出院。在仅限于接受 NIPPV 或 IMV 的患者的多变量分析中,与 IMV 相比,接受 NIPPV 的患者发生 IHCA 的几率较低(调整后的几率比 [aOR],0.07;95% CI,0.03-0.18)。在评估所有患者分类呼吸支持的二次分析中,与 IMV 相比,NIPPV 与较低的 IHCA 发生几率相关(aOR,0.35;95% CI,0.14-0.87),而最小呼吸支持(无/鼻插管/湿化高流量鼻插管 [aOR,0.56;95% CI,0.23-1.36])则无差异:支气管炎患儿心跳骤停的情况并不常见,仅占支气管炎重症监护病房收治人数的 1.2%。支气管炎患儿使用 NIPPV 可降低 IHCA 的发生几率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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CiteScore
5.70
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审稿时长
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