无创通气可降低新生儿呼吸窘迫综合征的治疗成本及住院时间

2016-10-27 MedSci MedSci原创

据在2016 AAP全国会议及展览的一项研究结果显示,与气管插管治疗相比,使用无创通气治疗早产儿呼吸窘迫综合征的医疗费用较低,住院时间较短。研究人员收集了1997-2012年国家医疗保健费用和利用KID的数据来确定无创通气和气管插管在新生儿呼吸窘迫综合征患儿中的使用率,以及气管插管的预测,留置时间和平均成本。最终确定了595254例新生儿呼吸窘迫综合征,其中12%的患儿仅用无创通气治疗,51%的患

据在2016 AAP全国会议及展览的一项研究结果显示,与气管插管治疗相比,使用无创通气治疗早产儿呼吸窘迫综合征的医疗费用较低,住院时间较短。

研究人员收集了1997-2012年国家医疗保健费用和利用KID的数据来确定无创通气和气管插管在新生儿呼吸窘迫综合征患儿中的使用率,以及气管插管的预测,留置时间和平均成本。

最终确定了595254例新生儿呼吸窘迫综合征,其中12%的患儿仅用无创通气治疗,51%的患儿使用气管插管。结果表明,无创通气治疗的使用比例显着增加,从1997年的6%增加至2012年的17%。此外,使用无创通气治疗的患儿其治疗时间及成本均显著低于气管内插管治疗的患儿。

校正其他混杂因素,如健康保险、性别、早产和种族,分析显示接受无创通气治疗的患儿气管插管几率降低(aOR [95% CI],0.86 [ 0.85,0.87 ])。基于性别、种族、健康保险、出院时间,早产和感染的诊断(如脓毒症),动脉导管未闭,呼吸暂停和心动过缓来匹配患儿。结果发现,与使用气管插管的患儿相比,无创通气组患者治疗时间较短(N = 38911对:[ 95% CI] 25 [ 5.3,25.7 ] VS.33 [ 32.9,33.6 ]),治疗平均成本也较低(n = 29836对:[$/1k] [95% CI] 46.1 [45.5, 46.8] vs. 64.1 [63.2, 65.0])。

总体而言,无创通气治疗的使用节省了5亿4600万美元的医疗费用。与气管插管相比,无创通气降低了每位患者的LOS和治疗成本,并降低了气管插管的几率。

原始出处:


Non-invasive ventilation reduces cost, length of stay for neonates with respiratory distress syndrome. Healio,October 26, 2016.

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对于急性呼吸窘迫综合症(ARDS)患者来说,经面罩无创通气(NIV)并不能有效预防气管内插管。而经头盔式NIV或是更好的一种治疗方式。本研究旨在确定经头盔NIV能否降低ARDS患者的气管插管率。采用中心随机临床试验设计,共纳入了2012年10月3日至2015年9月21日在芝加哥大学内科ICU需要接受经面罩进行NIV至少8小时的83名ARDS患者(45%为女性;中位年龄为59岁;中位APACHE I

JAMA:LISA法或是预防早产儿支气管肺发育不良及死亡的更佳策略

目前用于预防早产儿支气管肺发育不良(BPD)的无创通气策略有多种,但是尚未确定最佳的无创通气策略。本研究旨在对比7种无创通气策略的效果,包括仅进行经鼻持续气道正压通气(CPAP),气管插管-气管内滴入肺表面活性物质(INSURE)、微创法肺表面活性物质注入(LISA),无创正压通气,表面活性剂雾化吸入,通过喉罩通气吸入表面活性剂,和机械通气。 研究人员检索了截止至2016年6月MEDLINE