Nurse-led analysis and predicting the risk of difficult weaning in mechanical ventilation for pediatric patients based on lung ultrasound
10.3760/cma.j.cn211501-20240112-00115
- VernacularTitle:护士主导基于肺部超声评估的机械通气患儿脱机困难预测分析研究
- Author:
Wenlan ZHANG
1
;
Hua LU
;
Hong REN
;
Suqin XIA
;
Wenyi LUO
Author Information
1. 福建医科大学妇儿临床医学院 福建省儿童医院（上海儿童医学中心福建医院）重症医学科，福州 350014
- Keywords:
Ultrasonography;
Child;
Forecasting;
Mechanical ventilation;
Weaning
- From:
Chinese Journal of Practical Nursing
2024;40(34):2649-2657
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the risk factors associated with difficult weaning in mechanical ventilation for pediatric patients and investigate the predictive value of utilizing lung ultrasound assessment to optimize preparation for weaning and enhance success rates, thereby establishing a scientific foundation.Methods:A multi-center, prospective observational study, convenience sampling was utilized to select 97 pediatric patients who underwent endotracheal intubation at the Shanghai Children's Medical Center affiliated with Shanghai Jiao Tong University School of Medicine and Fujian Provincial Children's Hospital between September 2022 and May 2023. Lung ultrasound scores (LUS), Pediatric Critical Illness Score (PCIS), indicators related to respiratory oxygenation function and follow-up weaning outcomes were collected within 48-72 hours post-mechanical ventilation and prior to the first spontaneous breathing trial. The predictive efficacy of LUS in conjunction with risk factors associated with weaning difficulty on pediatric weaning outcomes was evaluated independently.Results:Among the 97 children studied, there were 57 boys and 40 girls, with ages ranging from 1 month to 14 years. By following up with weaning outcomes, the pediatric patients were divided into 55 cases of successful weaning group and 42 cases of difficult weaning group. During 48-72 hours of mechanical ventilation, LUS ( OR=2.05, 95% CI 1.43-2.94, P<0.05) and PCIS ( OR=0.68, 95% CI 0.50-0.92, P<0.05) were early risk factors for subsequent difficulties in weaning. And meantime, the combination of LUS(≥20 points) and PCIS(≤72 points) could effectively predict the risk of difficult weaning with a sensitivity of 61.90%, specificity of 96.36%, and an area under curve value of 0.84. Furthermore, before the first spontaneous breathing test, LUS ( OR=4.29, 95% CI 2.36-7.81, P<0.05) and rapid shallow breathing index (RSBI) ( OR=1.84, 95% CI 1.01-3.36, P<0.05) were identified as risk factors for pediatric difficult weaning, and their combination LUS (≥16 points) and RSBI (>6.4) could predict the risk of difficult weaning more accurately with a sensitivity of 76.19%, specificity of 90.91%, and an area under curve value of 0.92. Conclusions:The application of pediatric ICU specialist nurses, based on bedside LUS combined with PCIS and RSBI, can effectively assess and identify the risk of children with difficult weaning in the early stage, and identify the risk factors, providing a scientific basis for implementing individualized pulmonary rehabilitation nursing and helping children successfully weaning.
