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细支气管炎婴儿接受高流量氧疗的随机试验
A Randomized Trial of High-Flow Oxygen Therapy in Infants with Bronchiolitis


Donna Franklin ... 呼吸系统疾病 • 2018.03.22
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摘要


背景

尽管高质量疗效证据有限,细支气管炎婴儿中经鼻导管高流量氧疗已越来越多的使用。重症监护治疗病房(ICU)外其他地方使用经鼻导管高流量氧疗的疗效尚不清楚。

 

方法

在该多中心、随机、对照试验中,我们将需要辅助氧疗的12月龄以下细支气管炎婴儿随机分配接受高流量氧疗(高流量组)或标准氧疗(标准治疗组)。标准治疗组婴儿如果病情满足治疗失败标准则可使用挽救性高流量氧疗。研究主要结局为因治疗失败所致护理升级(定义为满足4项临床标准中的≥3项:持续心动过速、呼吸急促、低氧血症、医院早期预警工具触发医学审查)。次要结局为住院时长、氧疗时长、向三级医院的转院率、入住ICU、插管、不良事件。

 

结果

分析纳入1,472名患者。高流量组护理升级百分比为12%(739名婴儿中87名),标准治疗组为23%(733名婴儿中167名)(风险差,-11个百分点,95%置信区间,-15%~-7%,P<0.001)。住院时长或者氧疗时长没有显著差异。两组各有1例气胸(<1%的婴儿)。标准治疗组167名治疗失败的婴儿中,102名(61%)对高流量挽救治疗有应答。

 

结论

在ICU外接受治疗的细支气管炎婴儿中,接受高流量氧疗的患者与标准氧疗组相比,因治疗失败而护理升级的发生率显著较低(由澳大利亚国家健康与医学研究委员会等资助;澳大利亚和新西兰临床试验注册号[Australian and New Zealand Clinical Trials Registry number],ACTRN12613000388718)。





作者信息

Donna Franklin, B.N., M.B.A., Franz E. Babl, M.D., M.P.H., Luregn J. Schlapbach, M.D., Ed Oakley, M.B., B.S., Simon Craig, M.B., B.S., M.H.P.E., M.P.H., Jocelyn Neutze, M.B., Ch.B., Jeremy Furyk, M.B., B.S., M.P.H.&T.M., John F. Fraser, M.B., Ch.B., Ph.D., Mark Jones, Ph.D., Jennifer A. Whitty, B.Pharm., Grad.Dip.Clin.Pharm., Ph.D., Stuart R. Dalziel, M.B., Ch.B., Ph.D., and Andreas Schibler, M.D.
From the Pediatric Critical Care Research Group, Centre for Children’s Health Research, Lady Cilento Children’s Hospital, and Mater Research Institute (D.F., L.J.S., A.S.), the Schools of Medicine (D.F., L.J.S., J.F.F., A.S.) and Public Health (M.J.), University of Queensland, and the Critical Care Research Group, Adult Intensive Care Service, Prince Charles Hospital (D.F., J.F.F.), Brisbane, the Paediatric Research in Emergency Departments International Collaborative (PREDICT), Parkville, VIC (D.F., F.E.B., E.O., S.C., J.N., J.F., S.R.D., A.S.), Royal Children’s Hospital, the Emergency Department, Murdoch Children’s Research Institute, and the Department of Paediatrics, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, VIC (F.E.B., E.O.), the Department of Medicine, School of Clinical Sciences, Monash University, and the Paediatric Emergency Department, Monash Medical Centre, Monash Health, Clayton, VIC (S.C.), and the College of Medicine and Dentistry, James Cook University, and the Emergency Department, Townsville Hospital, Townsville, QLD (J.F.) — all in Australia; the Department of Pediatrics, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland (L.J.S.); KidzFirst Middlemore Hospital and the University of Auckland (J.N.) and the Children’s Emergency Department, Starship Children’s Hospital, and Liggins Institute, University of Auckland (S.R.D.), Auckland, New Zealand; and Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, United Kingdom (J.A.W.). Address reprint requests to Dr. Schibler at the Centre for Children’s Health Research, Lady Cilento Children’s Hospital Precinct and Mater Research Institute, University of Queensland, Level 7, 62 Graham St., South Brisbane, QLD, 4101, Australia, or at a.schibler@uq.edu.au.

 

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