Combined Noninvasive Ventilation and Mechanical In-Exsufflator in the Treatment of Pediatric Acute Neuromuscular Respiratory Failure

被引：23
作者：
Chen, Tai-Heng [1 ,2 ]
Hsu, Jong-Hau [1 ,3 ,4 ]
Wu, Jiunn-Ren [1 ,3 ]
Dai, Zen-Kong [1 ,3 ]
Chen, I-Chen [1 ]
Liang, Wen-Chen [1 ]
Yang, San-Nan [1 ,4 ]
Jong, Yuh-Jyh [1 ,4 ,5 ,6 ]
机构：
[1] Kaohsiung Med Univ, Kaohsiung Med Univ Hosp, Dept Pediat, Kaohsiung 80708, Taiwan
[2] Kaohsiung Med Univ, Kaohsiung Med Univ Hosp, Div Pediat Emergency, Dept Emergency, Kaohsiung 80708, Taiwan
[3] Kaohsiung Med Univ, Coll Med, Fac Med, Dept Pediat, Kaohsiung 80708, Taiwan
[4] Kaohsiung Med Univ, Grad Inst Med, Coll Med, Kaohsiung 80708, Taiwan
[5] Kaohsiung Med Univ, Kaohsiung Med Univ Hosp, Dept Lab Med, Kaohsiung 80708, Taiwan
[6] Natl Chiao Tung Univ, Dept Biol Sci & Technol, Hsinchu, Taiwan
来源：
PEDIATRIC PULMONOLOGY | 2014年 / 49卷 / 06期
关键词：
acute respiratory failure; neuromuscular disease; noninvasive ventilation; mechanical in-exsufflator; ENDOTRACHEAL INTUBATION; CONSENSUS STATEMENT; INSUFFLATION-EXSUFFLATION; COUGH AUGMENTATION; DISEASE; CARE; STANDARD; CHILDREN; INSUFFLATION/EXSUFFLATION; INSUFFICIENCY;
D O I：
10.1002/ppul.22827
中图分类号：
R72 [儿科学];
学科分类号：
100202 ;
摘要：
ObjectivesThe present study aims to evaluate the efficacy and complications of combined noninvasive ventilation (NIV) and assisted coughing by mechanical in-exsufflator (MIE) for acute respiratory failure (ARF) in children with neuromuscular disease (NMD). MethodsA prospective study was conducted in the pediatric intensive care unit. Children with NMD and ARF treated by combined NIV and MIE were included. Treatment success was defined as freedom from tracheal intubation during the hospital stay. Physiologic indices including PaO2, PaCO2, pH, and PaO2/FiO(2) were recorded before and 12, 24hr after the use of NIV/MIE. ResultsCombined NIV/MIE was used in 15 NMD children (mean: 8.1 years, range: 3 months to 18 years) with 16 cases of ARF. There was no mortality in this cohort. Treatment success was achieved in 12 cases (75%), including six cases (38%) demanding Do Not Intubate. ARF was due to pneumonia, with a mean baseline PaCO2 of 73.219.0mmHg. In the success group, hypercarbia and acidosis improved after use of NIV/MIE for 24hr (PaCO2: 71.7 +/- 18.6mmHg vs. 55.8 +/- 11.6mmHg, P<0.01; pH: 7.29 +/- 0.07 vs. 7.38 +/- 0.05, P<0.01). All patients tolerated NIV/MIE well despite transient skin pressure sores in five cases. ConclusionsCombined NIV/MIE is a safe and effective approach to rapidly improve physiologic indices and decrease the need for intubation in NMD children with ARF. NIV/MIE provides a good alternative for those refusing intubation. Pediatr Pulmonol. 2014; 49:589-596. (c) 2013 Wiley Periodicals, Inc.
引用
收藏
页码：589 / 596
页数：8
相关论文
共 31 条
  • [11] Spinal muscular atrophy type 1: Are proactive respiratory interventions associated with longer survival?
    Lemoine, Tara J.
    Swoboda, Kathryn J.
    Bratton, Susan L.
    Holubkov, Richard
    Mundorff, Michael
    Srivastava, Rajendu
    [J]. PEDIATRIC CRITICAL CARE MEDICINE, 2012, 13 (03) : E161 - E165
  • [12] A novel FKRP gene mutation in a Taiwanese patient with limb-girdle muscular dystrophy 2I
    Lin, Yi-Ching
    Murakami, Terumi
    Hayashi, Yukiko K.
    Nishino, Ichizo
    Nonaka, Ikuya
    Yuo, Chung-Yee
    Jong, Yuh-Jyh
    [J]. BRAIN & DEVELOPMENT, 2007, 29 (04) : 234 - 238
  • [13] Use of the mechanical in-exsufflator in pediatric patients with neuromuscular disease and impaired cough
    Miske, LJ
    Hickey, EM
    Kolb, SM
    Weiner, DJ
    Panitch, HB
    [J]. CHEST, 2004, 125 (04) : 1406 - 1412
  • [14] Cough augmentation in amyotrophic lateral sclerosis
    Mustfa, N
    Aiello, M
    Lyall, RA
    Nikoletou, D
    Olivieri, D
    Leigh, PN
    Davidson, AC
    Polkey, MI
    Moxham, J
    [J]. NEUROLOGY, 2003, 61 (09) : 1285 - 1287
  • [15] USE OF BIPAP(R) BY NASAL MASK IN THE TREATMENT OF RESPIRATORY INSUFFICIENCY IN PEDIATRIC-PATIENTS - PRELIMINARY INVESTIGATION
    PADMAN, R
    LAWLESS, S
    VONNESSEN, S
    [J]. PEDIATRIC PULMONOLOGY, 1994, 17 (02) : 119 - 123
  • [16] The Pathophysiology of Respiratory Impairment in Pediatric Neuromuscular Diseases
    Panitch, Howard B.
    [J]. PEDIATRICS, 2009, 123 : S215 - S218
  • [17] Noninvasive ventilation in childhood acute neuromuscular respiratory failure: A pilot study
    Piastra, M.
    Antonelli, M.
    Caresta, E.
    Chiaretti, A.
    Polidori, G.
    Conti, G.
    [J]. RESPIRATION, 2006, 73 (06) : 791 - 798
  • [18] BiPAP in acute respiratory failure due to myasthenic crisis may prevent intubation
    Rabinstein, A
    Wijdicks, EFM
    [J]. NEUROLOGY, 2002, 59 (10) : 1647 - 1649
  • [19] COMPLICATIONS OF ENDOTRACHEAL INTUBATION AND MECHANICAL VENTILATION IN INFANTS AND CHILDREN
    RIVERA, R
    TIBBALLS, J
    [J]. CRITICAL CARE MEDICINE, 1992, 20 (02) : 193 - 199
  • [20] Serrano MC, 2010, ARCH NEUROL-CHICAGO, V67, P1089, DOI 10.1001/archneurol.2010.207
1234