Roca Oriol, de Acilu Marina García, Caralt Berta, Sacanell Judit, Masclans Joan R
1 Critical Care Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain. 2 CibeRes, Instituto de Salud Carlos III, Madrid, Spain. 3 Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain.
Transplantation. 2015 May;99(5):1092-8. doi: 10.1097/TP.0000000000000460.
The effectiveness of humidified high flow nasal cannula (HFNC) in lung transplant (LTx) recipients readmitted to intensive care unit (ICU) because of acute respiratory failure (ARF) has not been determined to date.
Retrospective analysis of a prospectively assessed cohort of LTx patients who were readmitted to ICU because of ARF over a 5-year period. Patients received conventional oxygen therapy (COT) or HFNC (Optiflow, Fisher & Paykel, New Zealand) supportive therapy according to the attending physician's criteria. Treatment failure was defined as the need for subsequent mechanical ventilation (MV).
Thirty-seven LTx recipients required ICU readmission, with a total of 40 episodes (18 COT vs. 22 HFNC). At ICU admission, no differences in comorbidities, pulmonary function, or median sequential organ failure assessment (COT, 4 [interquartile range, 4-6] vs. HFNC, 4 [interquartile range, 4-7]; P = 0.51) were observed. Relative risk of MV in patients with COT was 1.50 (95% confidence interval [95% CI], 1.02-2.21). The absolute risk reduction for MV with HFNC was 29.8%, and the number of patients needed to treat to prevent one intubation with HFNC was 3. Multivariate analysis showed that HFNC therapy was the only variable at ICU admission associated with a decreased risk of MV (odds ratio, 0.11 [95% CI, 0.02-0.69]; P = 0.02). Moreover, nonventilated patients had an increased survival rate (20.7% vs. 100%; relative rate 4.83 [95% CI, 2.37-9.86]; P < 0.001). No adverse events were associated with HFNC use.
HFNC O2 therapy is feasible and safe and may decrease the need for MV in LTx recipients readmitted to the ICU because of ARF.
因急性呼吸衰竭（ARF）再次入住重症监护病房（ICU）的肺移植（LTx）受者中，高流量鼻导管湿化吸氧（HFNC）的有效性迄今尚未确定。
对一组前瞻性评估的LTx患者进行回顾性分析，这些患者在5年期间因ARF再次入住ICU。患者根据主治医生的标准接受传统氧疗（COT）或HFNC（新西兰费雪派克医疗保健公司的Optiflow）支持治疗。治疗失败定义为需要后续机械通气（MV）。
37例LTx受者需要再次入住ICU，共发生40次事件（18次COT vs. 22次HFNC）。在ICU入院时，未观察到合并症、肺功能或序贯器官衰竭评估中位数存在差异（COT组为4[四分位间距，4 - 6]，HFNC组为4[四分位间距，4 - 7]；P = 0.51）。接受COT治疗的患者进行MV的相对风险为1.50（95%置信区间[95%CI]，1.02 - 2.21）。HFNC预防MV的绝对风险降低率为29.8%，采用HFNC预防一次插管所需治疗的患者数量为3例。多变量分析显示，HFNC治疗是ICU入院时与MV风险降低相关的唯一变量（比值比，0.11[95%CI，0.02 - 0.69]；P = 0.02）。此外，未进行通气的患者生存率更高（20.7% vs. 100%；相对率4.83[95%CI，2.37 - 9.86]；P < 0.001）。使用HFNC未出现不良事件。
HFNC氧疗可行且安全，可能会减少因ARF再次入住ICU的LTx受者对MV的需求。
