有创机械通气患儿拔管结局预测指标有效性研究进展

Research advances in validity of predictors for extubation outcome in children receiving invasive mechanical ventilation

摘要:

有创机械通气技术的发展为危重症患儿提供了有效的呼吸支持，但危重症患儿呼吸支持并不是治疗终点，最终目的是使患儿成功拔除气管插管。目前一些拔管前评估指标，如浅快呼吸指数、最大吸气负压、呼吸功等在预测成人拔管结局方面具有较好的临床应用价值，但在儿科重症领域的循证医学证据并不充分。该文就目前国内外儿童拔管结局预测指标的有效性研究进行了综述，显示目前关于儿童拔管前评估尚缺乏敏感性和特异性均佳的指标，各项研究还处于小样本、单中心阶段。因此如何优化机械通气儿童拔管前的评估，提高拔管成功率是儿童重症监护科及康复科医生共同努力的方向。

Abstract:

The development of invasive mechanical ventilation technology provides effective respiratory support for critically ill children. However, respiratory support is not the end of treatment as the ultimate goal is successful extubation in children. At present, some evaluation indicators before extubation including rapid shallow breathing index, maximal inspiratory pressure, and work of breathing are of high clinical value in predicting adult extubation outcome, but their evidence of evidence-based medicine is not sufficient in the field of pediatric intensive care. This paper reviews the current research on the validity of predictors for extubation outcomes in children. It shows that there is still a lack of indicators with good sensitivity and specificity for assessment before extubation in children. The studies are still in a small-sample size and single-center stage. Therefore, how to optimize evaluation before extubation and improve the success rate of extubation is the direction of joint efforts of doctors in the pediatric intensive care unit and rehabilitation medicine department.