Iepsma, R. (René) (2017) Effect van spierverslapping bij mechanisch beademde kinderen met ARDS: een retrospectieve studie. thesis, Medicine.
Full text available on request.Abstract
Background Paediatric acute respiratory distress syndrome (PARDS) is a severe and life-threatening lung injury in children. The most important treatment option in PARDS is mechanical ventilation (MV) and has added significantly to the survival. However, MV also induces pulmonary inflammation, known as ventilation induced lung injury (VILI) and worsens pre-existing lung injury. Because there is no treatment for VILI, less ventilation is given to protect the lung from VILI. Though, sometimes this lung protective ventilation is not sufficient to achieve normal blood gas levels. Studies in adults with severe ARDS showed an improved survival when they were treated with neuro muscular blocking agents (NMBA), to stop spontaneous breathing. However, because adults have different lung physiology and immunology, it is not justified to use these study outcomes for treatment decision making in children. Therefore we analysed clinical outcomes in children with PARDS, that were treated with NMBA. Methods Children < 1 year old that were admitted to the PICU in December 2016 and January 2017 were included. We collected demographic characteristics (gender, weight, age, diagnosis, duration of MV, length of stay on the intensive care), medication use and several clinical outcome data (temperature, haemodynamic variables, respiratory variables, blood samples, Glasgow Coma Scale, and pupil reactions). Data were collected for a maximum of 5 days. Patients were divided in two groups: patients that received NMBA > 12 hours (NMBA group) and patients who did not receive NMBA (control group). The groups were compared with statistical tests: Mann-Whitney-U test for continuous variables, Chi-square test for ordinal variables and a Cox regression analysis. All tests were performed with IMB SPSS Statistics 23. Results In total 39 patients were included, 19 in the NMBA group and 20 in the control group. Median days of ventilation was 6.0, however patients in the NMBA group were significantly longer ventilated than patients in the control group (6.0 days vs. 4.0 days, p=0.012). Also, patients treated with NMBA were significantly younger and had a longer stay on the intensive care than the control group. Oxygenation index seems to improve more in the NMBA group than in the control group. Cox regression showed a significant relation with NMBA and the duration of ventilation (p=0.038). Also age influences duration of ventilation significantly (p=0.023). Conclusion This study shows that patients with PARDS, that are treated with NMBA, have significantly longer duration of MV and prolonged stay on the paediatric intensive care. This is possibly due to the difference in disease severity. However, NMBA seems to have a positive effect on the oxygenation index. More research is needed to investigate the effects of NMBA in PARDS.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Facultair Begeleider: and Kneyber, Martin and Beatrix Kinderziekenhuis, UMC Groningen |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:49 |
| Last Modified: | 25 Jun 2020 10:49 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/992 |
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