Evolución de pacientes con bronquiolitis tratados con cánulas de alto flujo de oxígeno que ingresan a la unidad de cuidados intensivos / Outcome of patients with bronchiolitis treated with high-flow oxygen nasal cannulas admitted to the intensive care unit

Objetivo: Describir la evolución en la Unidad de Cuidados Intensivos Pediátricos (UCIP) de los pacientes con bronquiolitis, tratados inicialmente con cánula nasal de alto flujo de oxígeno (CAFO) en la Unidad Emergencias. Determinar factores predisponentes de ingreso a ventilación no invasiva (VNI) o invasiva con intubación orotraqueal (TET). Métodos: Trabajo descriptivo retrospectivo por revisión de historias clínicas. Se incluyeron todos los pacientes menores de 2 años de edad con diagnóstico de bronquiolitis, sin comorbilidades, que ingresaron a UCIP polivalente luego de haber sido previamente tratados con CAFO en la Unidad de Emergencias entre los meses de Agosto 2017 y Agosto 2019. Resultados: Se evaluaron 145 pacientes. La mediana de edad fue de 4,4 meses (RIC 2-6 meses), con una mediana de tiempo desde el inicio de los síntomas hasta la consulta de 45,4 hs (RIC 24-72). La mediana del score de TAL modificado al ingreso a UCIP 8,4 (RIC 8-9). El 98,6% requirió asistencia respiratoria mecánica (ARM), en el grupo VNI 52,4% (75) y en el grupo TET 47,5% (68). El rescate de germen fue en 60% de los casos virus sincicial respiratorio (VSR). El 5,5% fueron co-infecciones. De los pacientes con rescate positivo para VSR, el 52,9% (46) requirieron VNI y 47,1% (41) TET. Los pacientes estudiados permanecieron en CAFO una mediana de 20 hs previo al ingreso a UCIP (RIC: 6-24). Aquellos que estuvieron en VNI con una mediana de 23,3 hs (RIC 6-24) y los que requirieron TET 17 hs (RIC 6-21). La mortalidad evidenciada en el grupo TET fue de 1,38% correspondiente a 2 pacientes, donde también se encontró un 7,5% de complicaciones. La mediana de días de internación en UCIP fue de 8,6 (5-11) para la totalidad de la población estudiada siendo 5,2 (4-6) para los pacientes en VNI y 12 días (9-14) para los pacientes en TET. Conclusiones: Casi la totalidad de pacientes tratados con CAFO en la Unidad Emergencias que requirieron pasar a UCI necesitaron ARM. Ni el score de TAL ni la cantidad de horas de CAFO previo al ingreso en UCI nos permitieron diferenciar los pacientes del grupo VNI de aquellos del grupo TET (AU)

Objective: To describe outcome of patients who were admitted to the pediatric intensive care unit (PICU) with bronchiolitis initially treated with high-flow oxygen through a nasal cannula (HFNC) at the emergency department and to determine predisposing factors for the need for non-invasive ventilation (NIV) or invasive endotracheal intubation (ETI). Methods: A retrospective descriptive study with a review of the clinical records was conducted. All patients less than 2 years of age with bronchiolitis without comorbidities that were admitted to the general PICU following treatment with HFNC at the emergency department between August 2017 and August 2019 were included in the study. Results: 145 patients were evaluated. Median age was 4.4 months (IQR 2-6 months). Median time from symptom onset to first consultation was 45.4 hours (IQR 24-72). Median modified TAL score on PICU admission was 8.4 (IQR 8-9). Overall 98,6% required mechanical ventilation (MV), 52.4% (75) in the NIV and 47.5% (68) in the ETI group. In 60% of the cases respiratory syncytial virus (RSV) was isolated. Co-infections were found in 5.5%. Of the patients with an RSV-positive isolate, 52.9% (46) required NIV and 47.1% (41) ETI. Patients had remained on HFNC for a median of 20 hours prior to PICU admission (IQR 6-24). Patients were on NIV for a median time of 23.3 hours (IQR 6-24) and on ETI for a median time of 17 hours (IQR 6-21). In the ETI group, mortality rate was 1.38%, corresponding to two patients, while the complication rate was 7.5%. Median length of PICU stay was 8.6 days (5-11) for the entire study population, 5.2 days (4-6) for patients on NIV, and 12 days (9-14) for those on ETI. Conclusions: Almost all patients treated with HFNC at the emergency department who required admission to the PICU needed MV. Neither TAL score nor time on HFNC allowed us to differentiate patients requiring NIV from those who needed ETI (AU)

The research on the clinical effect of clustered NIV in the treatment for patients with AECOPD complicated with HE / 中国医学装备

Objective: To observe the clinical effect of clustered non-invasive mechanical ventilation strategy in the treatment for patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD) complicated with hypercapnia encephalopathy(HE) so as to evaluate the safety and effectiveness of the scheme. Methods: According to the inclusion criteria, 164 patients with AECOPD complicated with HE were divided into the observation group(74 cases) and the control group (90 cases) as the random method. The patients of observation group were treated with clustered non-invasive ventilation(NIV), and the patients of control group were treated with invasive mechanical ventilation(IMV). The blood gas indexes of the two groups before and after 2 hours of treatment were observed, and the improved situations of the two groups were evaluated by KPS score. Besides, the hospitalization time and the mechanical ventilation time of the two groups were observed, and the incidence of adverse events and case fatality rate of 1 year in the two groups were counted and analyzed, and the reliability of the clustered NIV scheme was further evaluated. Results: Before treatment, there were no significant differences in pH, oxygenation index(PaO2/FiO2), partial pressure of carbon dioxide in artery (PaCO2) level and KPS score between the two groups(t=1.021, t=1.301, t=0.985, t=1.017, P>0.05). Although these indicators were obviously improved after these patients of two groups were treated, the differences of them between before and after treatment were no significant(t=2.017, t=1.825, t=1.163, t=1.520, P>0.05). On the other hand, the differences of time of mechanical ventilation, the hospitalization time and the times of intubation between the observation group and the control group were significant(t=7.018, t=8.523, t=7.954, P<0.05). In the observation group, there were 12 cases were failure, and 4 patients died in hospital, while the number of died in hospital were 18 cases in control group, and the difference of the number of died in hospital between the two groups was significant(x2=5.631, P<0.05). Besides, the difference of complication between the two groups was significant(x2=7.014, P<0.05). And the difference of case fatality rate of 1 year between the two groups was no significant. Conclusion: It is safe and effective for patients with AECOPD complicated with HE to implement cluster noninvasive mechanical ventilation strategy on the basis of meeting the condition of non-invasive mechanical ventilation. And it has clinical application value.