【原】【罂粟摘要】全脸面罩结合神经调节辅助通气作为重症支气管炎婴儿的救援治疗

全脸面罩结合神经调节辅助通气作为重症支气管炎婴儿的救援治疗

贵州医科大学  麻醉与心脏电生理课题组

翻译：文春雷   编辑：周倩   审校：曹莹

背景

重症支气管炎患者通常需要无创通气（NIV）支持。在NIV失败的情况下，我们最近开始使用带有全脸面罩接口（TFM）的无创神经调节辅助通气（NIV-NAVA），并报告了我们在这种呼吸支持方式方面的经验。

方法

我们在日内瓦大学医院儿科重症监护病房进行了一项回顾性研究，时间范围为2022年10月至2023年5月。纳入标准为0至6个月的儿童，患有重症支气管炎，初始NIV失败并转为NIV-NAVA-TFM。

结果 

从49名因呼吸道合胞病毒（RSV）引起的支气管炎需要呼吸支持的儿童中，有10名（中位年龄61天（IQR 44–73））在持续气道正压通气（CPAP）或NIV失败后接受了NIV-NAVA治疗，使用TFM。患者在入院后8小时（IQR 3–22）转为TFM-NIV-NAVA，持续24.5小时（IQR 13–60）。启动TFM-NIV-NAVA后，患儿氧合在启动后1小时内显著改善，而经皮CO2值保持稳定。所有患者均不需要插管，且没有因接口不适或其他不良副作用而中断TFM的情况。所有患者均使用镇静剂，其中静脉注射右美托咪定的比例较高。中位辅助通气持续时间为2.5天（IQR 2–4），中位PICU住院时间为4.5天（IQR 3–6）。  

 结论 

在重症RSV引起的支气管炎婴儿中，使用TFM-NIV-NAVA进行呼吸支持似乎是一种可行的救援治疗，可能在特定患者中考虑使用。

原始文献：Vladimir L. Cousin,  Tiphaine Corbisier, Peter C. Rimensberger, et al. Total face mask with neurally adjusted ventilatory assist as a rescue therapy in infants with severe bronchiolitis.[J]. European Journal of Pediatrics, 2024, 183: 2813–2817.

Total face mask with neurally adjusted ventilatory assist as a rescue therapy in infants with severe bronchiolitis

Background: Severe bronchiolitis patients are often supported with non-invasive ventilation (NIV). In case of NIV failure, we recently 

started to use non-invasive neurally adjusted ventilatory assist ventilation (NIV-NAVA) with a total face mask interface (TFM) and report now our experience with this modality of respiratory support. 

Methods: Retrospective study was made from October 2022 to May 2023 at the Geneva University Hospital Paediatric Intensive Care Unit. Inclusion criteria were children, aged from 0 to 6 months, with severe bronchiolitis with initial NIV failure and switch to NIV-NAVA-TFM. 

Results: From 49 children with respiratory syncytial virus (RSV)-induced bronchiolitis requiring any form of respiratory support, 10 (median age 61 days 

(IQR 44–73) failing CPAP or NIV underwent rescue treatment with NIV-NAVA using a TFM. Patients were switched to TFM-NIV-NAVA 8 h (IQR 3–22) after admission for 24.5 h (IQR 13–60). After initiation of TFM-NIV-NAVA, oxygenation improved significantly as early as 1 h after initiation, whereas transcutaneous CO2 values remained stable. None of the patients needed to be intubated and there was no episode of TFM discontinuation due to interface discomfort or other unwanted side effects. Sedation was used in all patients with high proportion of intravenous dexmedetomidine. Median ventilatory assistance duration was 2.5 days (IQR 2–4) and median PICU stay was 4.5 (IQR 3–6).

Conclusion: In infants with severe RSV-induced bronchiolitis, respiratory support with TFM-NIV-NAVA seems to be feasible as a rescue therapy and might be considered in selected patients.

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