Abstract
Objective To investigate the guiding value of end-tidal carbon dioxide partial pressure(PETCO2)in preventing hypoxemia in children with bronchopneumonia undergoing high-flow oxygen therapy.Methods A total of 269 children with bronchopneumonia admitted to Ya'an People's Hospital from January 2021 to November 2023 were included in the study,all of whom received high-flow oxygen therapy.Based on the presence or absence of hypoxemia,patients were divided into the hypoxemia group(n=97)and the non-hypoxemia group(n=172).General clinical data and blood gas analysis parameters were compared between the two groups.A generalized estimating equation(GEE)model was used to analyze the influencing factors of hypoxemia in children with bronchopneumonia.According to the classification criteria of hypoxemia severity,children in the hypoxemia group were further divided into a mild group and a moderate-to-severe group.General clinical data were compared between the two groups,and the dose-response relationship between PETCO2 and hypoxemia severity was analyzed.Results Compared with the non-hypoxemia group,children in the hypoxemia group were younger and had higher levels of CRP,Fib,DD,ESR,and LDH(t=2.436,9.635,3.530,14.384,9.137 and 10.486,respectively,P＜0.05).After 48 hours of treatment,SaO2 and PaO2 levels were significantly higher in the non-hypoxemia group than in the hypoxemia group,while PETCO2,pH,and PaCO2 levels were significantly lower(t=6.220,13.223,6.861,7.437 and 5.325,respectively,P＜0.05).Compared with baseline(0h),PaO2,pH,and SaO2 levels at 12h,24h,36h,and 48h were significantly increased,whereas PETCO2 and PaCO2 levels were significantly decreased(P＜0.05).CRP,Fib,DD,ESR,LDH,SaO2,PaO2,PaCO2,pH,and PETCO2 significantly influenced the occurrence of hypoxemia in children with bronchopneumonia(OR:1.810-3.554,P＜0.05).Compared with children in the mild group,those in the moderate-to-severe group had a higher proportion of age ≤3 years and disease duration ≥7 days,as well as higher levels of CRP,Fib,DD,PETCO2,and PaCO2,but lower levels of SaO2,pH,and PaO2(P＜0.05).A restricted cubic spline model showed a nonlinear dose-response relationship between PETCO2 levels and hypoxemia severity in children with bronchopneumonia(P＜0.001).Conclusion PETCO2 has guiding value in preventing hypoxemia during high-flow oxygen therapy in children with bronchopneumonia.The level of PETCO2 is nonlinearly associated with hypoxemia severity,and elevated PETCO2 increases the risk of hypoxemia.关键词
患儿/支气管肺炎/低氧血症/呼气末二氧化碳分压/高流量辅助通气Key words
child/bronchopneumonia/hypoxemia/end-tidal carbon dioxide partial pressure/high-flow oxygen therapy分类
预防医学
