Russian Journal of Pediatric Surgery, Anesthesia and Intensive CareRussian Journal of Pediatric Surgery, Anesthesia and Intensive CareРоссийский вестник детской хирургии, анестезиологии и реаниматологии2219-40612587-6554Eco-Vector129210.17816/psaic1292Original Study ArticlesОригинальные исследованияResearch ArticleRespiratory parameters as a predictor of hospital outcomes in newborns requiring medical evacuationРеспираторные параметры как предиктор исходов госпитального этапа у новорожденных, требующих медицинской эвакуацииhttps://orcid.org/0000-0003-4030-53384206-3303MukhametshinRustam F.МухаметшинРустам Фаридович
Russian Federation

Cand. Sci. (Med.), Assistant Professor, Head of the Department

канд. мед. наук, доцент, заведующий отделением

rustamFM@yandex.ruhttps://orcid.org/0000-0002-5250-73519919-9048KovtunOlga P.КовтунОльга Петровна
Russian Federation

Dr. Sci. (Med.), Professor, Academician of Academy of Sciences

д-р мед. наук, профессор, академик РАН

kovtun@usma.ruhttps://orcid.org/0000-0001-7842-62963766-8337DavydovaNadezhda S.ДавыдоваНадежда Степановна
Russian Federation

Dr. Sci. (Med.), Professor

д-р мед. наук, профессор

davidovaeka@mail.ruUral State Medical UniversityУральский государственный медицинский университетRegional Children’s Clinical HospitalОбластная детская клиническая больница03122022190120231244414522909202230112022Copyright ©; 2023, Eco-VectorCopyright ©; 2023, Эко-Вектор2023Eco-VectorЭко-Векторhttps://creativecommons.org/licenses/by-nc-nd/4.0https://rps-journal.ru/jour/article/view/1292

BACKGROUND: Assessment of the clinical condition, prediction of risks and possible outcomes during the transfer of newborns remains an important part of the work of transport teams. Respiratory disorders remain a significant indication for transfer to medical organizations of a higher level of care.

AIM: To study the predictive value of the parameters of respiratory support in newborns requiring medical evacuation for the outcomes of treatment.

MATERIALS AND METHODS: The observational, cohort, retrospective study included data from neonatal to patients on ventilators (286 newborns) in the period from August 1, 2017 to December 31, 2018. Anamnesis parameters, intensive care volume, respiratory support settings, and assessments on scales (KSHONN, NTISS, TRIPS) were evaluated. Analyzed: 24-hours mortality, 7 days mortality, hospital mortality, air leakage syndrome. The assessment and comparison of the predictive value of the parameters in relation to the hospital outcomes was performed.

RESULTS: The AUC ROC of SpO2/FiO2 for predicting 24-hours mortality was 0.984 [0.966–1.000], which is significantly higher than the ROC of the saturation oxygenation index (AUC 0.972 [0.949–0.995], p = 0.004). The area under the ROC of the 24-hours mortality on the TRIPS scale does not significantly differ from the saturation index of oxygenation (AUC 0.972 [0.949–0.995], p = 0.113) and the mean airway pressure (AUC 0.943 [0.884–1.000], p = 0.107). When predicting 7-day mortality, the saturation oxygenation index has AUC ROC (0.702 [0.549–0.854]) significantly lower than AUC ROC for SpO2/FiO2 (0.762 [0.638–0.887], p = 0.001). SpO2/FiO2 predicts total mortality with AUC ROC (0.759 [0.677–0.841]).

CONCLUSIONS: The mean airway pressure, saturation oxygenation index and SpO2/FiO2 have a high (AUC > 0,9) predictive value for 24-hours mortality, while only SpO2/FiO2 reliably predicts total mortality with AUC ROC > 0,7.

Актуальность. Оценка тяжести состояния пациента, прогнозирование рисков и возможных исходов при осуществлении медицинской эвакуации новорожденных остается важным разделом работы транспортных бригад. Дыхательные нарушения остаются значимым показанием для перевода в медицинские организации более высокого уровня помощи.

Цель — изучить предиктивную ценность параметров респираторной поддержки новорожденных, требующих медицинской эвакуации, в отношении исходов госпитального этапа лечения.

Материалы и методы. В обсервационное когортное ретроспективное исследование включены данные выездов неонатальной транспортной бригады к пациентам на ИВЛ (286 новорожденных) в период с 1 августа 2017 по 31 декабря 2018 г. Оценивали параметры анамнеза, объем интенсивной терапии и респираторной поддержки. Применяли три угрозометрические шкалы: клиническую шкалу оценки недоношенного новорожденного — КШОНН; cистему оценки неонатального терапевтического вмешательства — Neonatal Therapeutic Intervention Scoring System, NTISS; индекс физиологической стабильности транспортного риска для новорожденных — Transport Risk Index of Physiologic Stability for Newborn Infants, TRIPS. Проанализированы: досуточная летальность, 7-суточная летальность, общая летальность госпитального этапа, синдром утечки воздуха. Выполнен расчет и сравнение предиктивной ценности параметров в отношении исходов госпитального этапа.

Результаты. AUC ROC SpO2/FiO2 прогнозирования досуточной летальности составила 0,984 [0,966–1,000], что достоверно выше ROC сатурационного индекса оксигенации (AUC 0,972 [0,949–0,995], р = 0,004). Площадь под ROC-кривой прогнозирования досуточной летальности для оценки по шкале TRIPS достоверно не отличается от сатурационного индекса оксигенации (AUC 0,972 [0,949–0,995], р = 0,113) и среднего давления в дыхательных путях (AUC 0,943 [0,884–1,000], р = 0,107). При прогнозировании 7-суточной летальности сатурационный индекс оксигенации имеет AUC ROC (0,702 [0,549–0,854]) достоверно ниже, чем AUC ROC для SpO2/FiO2 (0,762 [0,638–0,887], р = 0,001). SpO2/FiO2 прогнозирует общую летальность с AUC ROC (0,759 [0,677–0,841]).

Заключение. Среднее давление в дыхательных путях, сатурационный индекс оксигенации и SpO2/FiO2 обладают высокой (AUC > 0,9) предиктивной ценностью в отношении досуточной летальности, при этом только SpO2/FiO2 достоверно с AUC ROC > 0,7 прогнозирует общую летальность.

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