Evaluation and nursing of continuous blood purification therapy on acute respiratory distress syndrome in children / 中华实用儿科临床杂志

ABSTRACT

Objective To investigate the efficacy of continuous blood purification (CBP) in treatment of acute respiratory syndrome (ARDS) in children,and the methods as well as the key points in nursing care.Methods There were 97 cases of ARDS,and 18 cases were treated with CBP.The model for CBP was continuous veno-venous hemofiltration dialysis (CVVHDF) or high volume hemofiltration (HVHF).The observational index included arterial partial pressure of oxygen [pa(O2)],arterial partial pressure of carbon dioxide [Pa(CO2)],mechanical ventilation parameters,complications and side reaction during CBP.Results The pediatric critical illness score in CBP treatment group and non-CBP treatment group were (62.5 ± 25.2) and (78.1 ± 16.3) respectively,and the difference between the 2 groups was significant (P ＜ 0.05) ; the median of pediatric risk of score mortality Ⅲ score in CBP treatment group and non-CBP treatment group were 16(10-20) and 12(7-14),and the difference was significant between the 2 groups (all P ＜0.05).The average duration of CBP in 18 cases was 58 hours(12-232 hours),death occurred in 5 cases,and 2 cases of them were due to giving up treatment,the mortality was 27.8％ ;while in non-CBP treatment group,21 cases occurred death and the mortality was 26.6％.The difference of mortality between the 2 groups was not significant (P ＞ 0.05).Pa (O2)/fraction of inspired oxygen (FiO2) and dynamic compliance (Cdyn) were improved after 2-6 hours CBP,and the pulmonary exudation alleviated after 2 hours treatment.Mechanical ventilation parameters including FiO2,peak inspiratory pressure and positive end expiratory pressure were reduced.The complications related with CBP treatment included aggravating anemia,thrombopenia,lower body temperature,hemorrhage,oliguria,thick sputum,pain and dysphoria.No serious lethal complication was observed.Conclusions CBP treatment is a safe and effective rescue method for ARDS in children,it can reduce pulmonary edema,improve pa (O2)/FiO2 and Cdyn,and improve mechanical ventilation parameters.During CBP therapy,the key points include monitoring vital sign and the changes of hemodynamic,keeping body position nursing care well,tranquilizing,as well as maintaining the pipe unobstructed.