Procena ishoda konvencionalne i visokofrekventne oscilatorne mehaničke ventilacije kod dece sa akutnim respiratornim distres sindromom
Evaluation of the outcomes of conventional mechanical ventilation and high frequency oscillatory mechanical ventilation in children with acute respiratory distress syndrome
Author
Rsovac, SnežanaMentor
Nestorović, BranimirCommittee members
Šćepanović, LjiljanaSimić, Dušica
Mitrović, Dušan M.
Mikić, Dragan
Metadata
Show full item recordAbstract
Cilj ove studije bio je da uporedi ishod lečenja konvencionalnom mehaničkom
ventilacijom i visokofrekventnom oscilatornom ventilacijom kod dece sa akutnim respiratornim
distres sindromom.
Metoda istraživanja: Ispitivanje je dizajnirano kao retrospektivno-prospektivna studija,
sprovedena na odeljenju pedijatrijskog intenzivnog lečenja Univerzitetske dečje klinike u
Beogradu, u periodu od aprila 2011. do marta 2016.godine. Ispitivanje je sprovedeno na 70
bolesnika, uzrasta od 1 meseca do 7. godine života, kod kojih je postavljena dijagnoza akutnog
respiratornog distres sindroma (ARDS). Pacijente smo podelili u dve kategorije: odojčad (do 12
meseci starosti), decu starosti 1-7 godina. Svi pacijenti su inicijalno, u prvom danu lečenja ARDS,
tretirani konvencionalnom protektivnom mehaničkom ventilacijom. Zatim su prevođeni na HFOV
ukoliko su imali pogoršanje indeksa oksigenacije, odstupanje od minimum 20% inicijalnih
vrednosti za gasne analize ili pogoršanje (radiografija pluća, smanjenje P...aO2/FiO2 odnosa).
Rezultati: Mehanička ventilacija (MV) započeta je u proseku 2,3 dana od prijema (medijana 1,0;
maksimalno 14 dana). Prosečno trajanje MV za sve pacijente je bilo 11,8 (medijana, 7,0) dana.
Prosečna vrednost OI 1. dana MV iznosila je 14.01 (SD, 5.34), a 3. dana MV 16.41 (SD, 8.82).
Analiza OI prvog i trećeg dana MV otkrila je da je OI trećeg dana MV bio značajan prediktor
mortaliteta (OR, 256,5, 95% CI 27,1-2424, p < 0,001; positivna prediktivna vrednost 0.905;
negativna prediktivna vrednost 0.964).Nije postojala statistički značajna razlika u ishodu dece sa
ARDS koja su lečena konvencionalnom mehaničkom ventilacijom u odnosu na decu lečenu visoko
frekventnom oscilatornom mehaničkom ventilacijom (p > 0.05).
Zaključak: Ishodi kod pedijatrijskih ARDS pacijenata lečenih konvencionalnom mehaničkom
ventilacijom i visokofrekventnom oscilatornom ventilacijom nisu značajno različiti
The aim of this study was to compare the outcomes between conventional and high
frequency oscillatory ventilation in children with acute respiratory distress syndrome.
Methods: This study was designed as a retrospective-prospective study, conducted at the
Department of Pediatric Intensive Care of the University Children's Hospital in Belgrade, in the
period from April 2011 to March 2016. The study was conducted on 70 patients, aged from 1
month to 7 years of age, who were diagnosed with acute respiratory distress syndrome. We divided
patients into two categories: infants (up to 12 months of age), children (from 1 to 7 years of
age). All patients were initially treated with conventional protective mechanical ventilation on the
first day of ARDS treatment. They were then transferred to HFOV if they had a worsening of the
oxygenation index and / or a deviation of at least 20% of the initial values blood gasor had
worsening (lung radiography, decreasingPaO2 / FiO2).
Results: Mechanical ven...tilation was initiated a mean of 2.3 days after admission (median, 1.0;
maximum 14 days). Average mechanical ventilation duration for all patients was 11.8 (median,
7.0) days. Analysis of OI on the first and third days of MV revealed that OI on the third day of
MV was a highly significant predictor of mortality (OR, 256.5, 95%CI 27.1-2424, p < 0,001;
positive predictive value, 0.905; negative predictive value, 0.964). Different modes of mechanical
ventilation were not significantly predictor of the survival (short-term mortality) of children
mechanically ventilated for ARDS.
Conclusion: Outcomes in pediatric ARDS patients treated with conventional mechanical
ventilation and high frequency oscillatory ventilation are notsignificant different. OI is a simple
and sensitive predictor of the survival (short-term mortality) od children mechanically ventilated
for ARDS.