美国费城儿童医院Martha A.Q. Curley团队联合华盛顿大学R. Scott Watson团队研究了儿童早期急性呼吸衰竭与长期神经认知结果的相关性。2022年3月1日出版的《美国医学会杂志》发表了这项成果。

每年大约有23700名美国儿童因急性呼吸衰竭接受有创机械通气治疗，但这对神经认知功能的长期影响未知。

为了评估因急性呼吸衰竭而在儿科重症监护病房（PICU）住院的儿童与其亲生兄弟姐妹的神经认知结果，研究组在美国31个PICU和相关神经心理学测试中心进行了一项前瞻性同胞匹配队列研究。患儿年龄为8岁及以下，在PICU入院前儿童大脑功能分类得分为1（正常），在PICU出院时小于或等于3（不比中度神经认知功能障碍严重），不包括有神经认知缺陷病史或再次入院并接受机械通气的患者。

测试时，亲生兄弟姐妹的年龄在4至16岁之间，儿童大脑功能类别得分为1，没有机械通气或全身麻醉史。2014年9月2日至2017年12月13日，共有121对兄弟姐妹被纳入研究，并从2015年3月14日开始接受神经认知测试。最终随访日期为2018年11月6日。

暴露条件为急性呼吸衰竭的危重病和PICU治疗。主要结局为智商，通过韦氏智力量表中与年龄相适应的词汇和模块设计子测验进行评估。次要结局包括对注意力、处理速度、学习和记忆、视觉空间技能、运动技能、语言和执行功能的测量。出院后3 - 8年进行评估。

121位患儿中55名（45%）为女性，中位年龄（IQR）1.0岁时接受了PICU护理，接受了中位5.5天的有创机械通气，并在中位年龄（IQR）6.6岁时接受了测试。共有121名匹配的兄弟姐妹，72名（60%）为女性。兄弟姐妹在中位（IQR）8.4岁时接受测试。

患儿的平均智商估计值为101.5分，低于匹配的兄弟姐妹（104.3分）。在次要结局中，患儿在非语言记忆、视觉空间技能和精细运动控制方面的得分显著低于匹配的兄弟姐妹，但处理速度分数显著较高。其余的次要结局，包括注意力、非文字记忆、表达语言和执行功能，均没有显著差异。

研究结果表明，在儿童中，因呼吸衰竭而住院且出院时无严重认知功能障碍的PICU存活患者与匹配的兄弟姐妹相比，后续智商得分显著降低。然而，差异的幅度很小，临床意义不确定。

附：英文原文

Title: Association of Acute Respiratory Failure in Early Childhood With Long-term Neurocognitive Outcomes

Author: R. Scott Watson, Sue R. Beers, Lisa A. Asaro, Cheryl Burns, Min Jung Koh, Mallory A. Perry, Derek C. Angus, David Wypij, Martha A.Q. Curley, RESTORE-Cognition Investigators, Joseph Ackerson, Mary Best, Alanna A. Conder, Natalie Z. Cvijanovich, Rachyll Dempsey, Monica D. Dowling, Susanne W. Duvall, Andrea Fabricatore, Chaya B. Gopin, Lana L Harder, Abbey Herringshaw, Kate Herrington, James H. Hertzog, Scott J. Hunter, Nicolle Ionascu, Gad E. Klein, Roger E. Lauer, Jonathan D. Lichtenstein, Margaret M. Manning, Ryan Martin, Joan W. Mayfield, Megan M Morse, Edward M. Moss, Grace A. Mucci, Ana Ramirez, Syndey A. Rice, Marivelisse Rodriquez-Rivera, Cynthia F. Salorio, Anabela D. Smith, Julien T. Smith, Nina H. Thomas, Allison Thomas, J. Robin Timm, LuAnn VanDetta, Marion Wallace, Seth A. Warschausky, William J. Warzak, Desiree A. White, Elizabeth J. Willen, Lisa J. Woodcock-Burroughs, Maya M. Zayat

Issue&Volume: 2022/03/01

Abstract:

Importance  Approximately 23700 US children undergo invasive mechanical ventilation for acute respiratory failure annually, with unknown long-term effects on neurocognitive function.

Objective  To evaluate neurocognitive outcomes of children who survive pediatric intensive care unit (PICU) hospitalization for acute respiratory failure compared with their biological siblings.

Design, Setting, and Participants  Prospective sibling-matched cohort study conducted at 31 US PICUs and associated neuropsychology testing centers. Patients were 8 years or younger with a Pediatric Cerebral Performance Category score of 1 (normal) before PICU admission and less than or equal to 3 (no worse than moderate neurocognitive dysfunction) at PICU discharge, excluding patients with a history of neurocognitive deficits or who were readmitted and underwent mechanical ventilation. Biological siblings were aged 4 to 16 years at testing, with Pediatric Cerebral Performance Category score of 1 and no history of mechanical ventilation or general anesthesia. A total of 121 sibling pairs were enrolled from September 2, 2014, to December 13, 2017, and underwent neurocognitive testing starting March 14, 2015. The date of the final follow-up was November 6, 2018.

Exposures  Critical illness and PICU treatment for acute respiratory failure.

Main Outcomes and Measures  The primary outcome was IQ, estimated by the age-appropriate Vocabulary and Block Design subtests of the Wechsler Intelligence Scale. Secondary outcomes included measures of attention, processing speed, learning and memory, visuospatial skills, motor skills, language, and executive function. Evaluations occurred 3 to 8 years after hospital discharge.

Results  Patients (n=121; 55 [45%] female patients) underwent PICU care at a median (IQR) age of 1.0 (0.2-3.2) years, received a median (IQR) of 5.5 (3.1-7.7) days of invasive mechanical ventilation, and were tested at a median (IQR) age of 6.6 (5.4-9.1) years. Matched siblings (n=121; 72 [60%] female siblings) were tested at a median (IQR) age of 8.4 (7.0-10.2) years. Patients had a lower mean estimated IQ than matched siblings (101.5 vs 104.3; mean difference, –2.8 [95% CI, –5.4 to –0.2]). Among secondary outcomes, patients had significantly lower scores than matched siblings on nonverbal memory (mean difference, –0.9 [95% CI, –1.6 to –0.3]), visuospatial skills (mean difference, –0.9 [95% CI, –1.8 to –0.1]), and fine motor control (mean difference, –3.1 [95% CI, –4.9 to –1.4]) and significantly higher scores on processing speed (mean difference, 4.4 [95% CI, 0.2-8.5]). There were no significant differences in the remaining secondary outcomes, including attention, verbal memory, expressive language, and executive function.

Conclusions and Relevance  Among children, survival of PICU hospitalization for respiratory failure and discharge without severe cognitive dysfunction was associated with significantly lower subsequent IQ scores compared with matched siblings. However, the magnitude of the difference was small and of uncertain clinical importance.

DOI: 10.1001/jama.2022.1480

Source: https://jamanetwork.com/journals/jama/article-abstract/2789542