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NEJM:经鼻插管高流量氧疗用于婴幼儿细支气管炎

2018-03-22 zhangfan MedSci原创

研究认为,对于因细支气管炎接受氧疗的非ICU患儿,高流量氧疗可显著降低治疗失败率

经鼻插管高流量氧疗在婴幼儿细支气管炎中的应用越发普遍,但其疗效尚缺少高质量的研究证据,近日研究人员考察了高流量氧疗对非ICU婴幼儿细支气管炎的治疗效果。

12个月以下因细支气管炎接受氧疗的患儿随机接受高流量氧疗或标准氧疗。研究的主要终点为治疗失败(即持续性心动过速、呼吸暂停、低氧血症等),次要终点包括住院时间、氧疗时间、转院及ICU治疗率、插管和不良事件等。

1472名患者参与研究, 12%的高流量组(87/739)以及23%的标准治疗组(167/733)患儿因治疗失败接受护理升级(风险差异为11%)。组间住院及氧疗时间无显著差异,各组均发生1例气胸。标准治疗组167名治疗失败的患儿中,102人(61%)在接受高流量氧疗后出现治疗响应。

研究认为,对于因细支气管炎接受氧疗的非ICU患儿,高流量氧疗可显著降低治疗失败率。

原始出处:

Donna Franklin et al. A Randomized Trial of High-Flow Oxygen Therapy in Infants with Bronchiolitis. N Engl J Med. March 22, 2018.

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    2018-03-26 张新亮1853311252142e2fm

    好文章.学习了

    0

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    2018-03-24 rgjl

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研究人员观察到由于严重的细支气管炎引起的医疗负担日益加重,临床实践中的主要变化从侵入性到非侵入性支持提示细支气管炎患者进入ICU的阈值已经改变。未来的研究应评估在ICUs外细支气管炎的治疗策略。

Chest:静脉予以硫酸镁治疗细支气管炎并无益处!

为了确定静脉予以镁是否可以用于严重的儿童哮喘,减少细支气管炎患者出院时的医疗准备时间。近期,一项发表在杂志Chest上的研究比较了静脉内予以单次100mg / kg剂量的硫酸镁及安慰剂治疗急性细支气管炎。如果患者既往有湿疹和/或哮喘家族史,则接受支气管扩张剂,雾化高渗盐水和5天地塞米松治疗。出院的医疗时间是主要疗效结果。次要结果是支气管炎严重程度评分,需要医院或2周内再次门诊就诊。心肺不稳定性发作

LANCET:细支气管炎患儿应该采用何种氧疗方式?

细支气管炎是婴儿中最常见的肺部感染,治疗重点在于纠正呼吸窘迫和缺氧。目前,高流量暖湿润氧(HFWHO)越来越多地使用,但没有进行严格的随机试验研究。近期,一项发表在权威杂志LANCET上的文章研究了HFWHO是否能够增强呼吸支持,缩短予氧时间。这项研究是开放的、四期随机对照试验,研究者们招募了年龄小于24个月的患有中度细支气管炎的儿童,他们均就诊于约翰·亨特医院的急诊科或澳大利亚新南威尔士约翰·亨

Am J Resp Crit Care:鼻咽部微生物和代谢组学与细支气管炎的严重程度相关性分析!

由此可见,多组学分析不仅验证了采用代谢组学的方法来确定细支气管炎严重程度的能力,而且与细支气管炎病理机制中的微生物和宿主之间存在相互关系。

Allergy:循环25羟维生素D、鼻咽部气道代谢组和细支气管炎严重程度的关系!

基于多中心的研究数据,维生素D代谢产物与毛细支气管炎的严重程度风险相关。

Pediatrics:细支气管炎患儿雾化时选择高渗盐水还是生理盐水?

细支气管炎是美国1岁以下新生儿最常见的住院原因,目前除了支持性治疗,没有其他有效的治疗方案。研究者进行了一项研究,探究雾化吸入3%高渗盐水(HS)或生理盐水(NS)对婴幼儿住院时长(LOS)的影响。该前瞻性、随机、双盲、对照试验纳入了227名诊断为细支气管炎的小于1岁的患儿(其中190名患儿完成了试验),113名患儿随机分到HS组(93名患儿完成了试验),114名随机分到NS组(97名患儿完成了试

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