Zhao Huiying, Luo Jian, Lyu Jie, Wang Huixia, Ji Huijuan, An Youzhong
Department of Critical Care Medicine, Peking University People's Hospital, Beijing 100044, China.
Ji'an County People's Hospital, Ji'an 343100, Jiangxi, China. Corresponding author: An Youzhong, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2019 Jun;31(6):689-693. doi: 10.3760/cma.j.issn.2095-4352.2019.06.006.
To investigate the characteristics and failure risk factors of sequential high-flow nasal cannula oxygen therapy (HFNC) after weaning from invasive ventilation.
The patients who received sequential HFNC after weaning from invasive ventilation admitted to surgical intensive care unit (ICU) of Peking University People's Hospital from June 1st 2016 to May 31st 2018 were retrospectively analyzed. Clinical variables, respiratory therapy parameters, respiratory variables, cardiac variables and outcomes were reviewed and analyzed. Treatment characteristics of HFNC after weaning was analyzed. Patients were divided into HFNC success group and HFNC failure group according to the failure of HFNC, and the differences between the two groups were compared. The independent risk factors of HFNC treatment failure were analyzed by Logistic regression analysis. The value of predictive treatment failure of risk factors and regression models were analyzed by receiver operating characteristic (ROC) curve.
A total of 99 patients were included, 61 men, and the median age was 67.0 (57.0, 76.0) years old. The medianinitial HFNC flow was 50 (50, 60) L/min, and inspired oxygen concentration (FiO) was 0.50 (0.40, 0.60). Eighteen patients experienced HFNC failure (18.2%). Compared with the HFNC success group, the sequential organ failure assessment (SOFA) score in the HFNC failure group was higher [4 (3, 5) vs. 2 (1, 3), P < 0.01], B type natriuretic peptide (BNP) before HFNC therapy were significant higher [ng/L: 647.2 (399.2, 1 331.3) vs. 127.2 (55.2, 369.5), P < 0.01], and respiratory frequency (RR) and heart rate (HR) were significant faster, mean arterial pressure (MAP) was significant higher, oxygen index (PaO/FiO) was significant lower after 30 minutes HFNC treatment [RR (times/min): 26 (22, 28) vs. 19 (17, 21), HR (bpm): 105 (97, 107) vs. 85 (77, 90), MAP (mmHg, 1 mmHg = 0.133 kPa): 104.3 (101.7, 110.7) vs. 92.3 (88.3, 97.7), PaO/FiO (mmHg): 207.3 (185.8, 402.8) vs. 320.2 (226.2, 361.5), all P < 0.05]. It was shown by multiple Logistic regression analysis that the SOFA score [odds ratio (OR) = 2.818, P = 0.022, β = 1.036], BNP before HFNC treatment (OR = 1.002, P = 0.033, β = 0.002) and HR after HFNC treatment 30 minutes (OR = 1.140, P = 0.032, β = 0.131) were independent risk factors for HFNC treatment failure. It was shown by ROC curve that the area under the ROC curve (AUC) for the prediction of HFNC failure was 0.840, 0.859, 0.860 and 0.962 for SOFA, BNP before HFNC treatment, HR after HFNC treatment 30 minutes, and regression model, all had good forecast values (all P < 0.01).
HFNC is one of the commonly used oxygen therapy methods in the ICU, but not all patients who are treated as a sequential therapy after invasive mechanical ventilation weaning can benefit from it. SOFA score, BNP before HFNC treatment and HR after 30 minutes HFNC treatment were independent risk factors of HFNC failure. Each independent risk factor and regression model can predict the success of HFNC treatment.
探讨有创通气撤机后序贯高流量鼻导管吸氧疗法（HFNC）的特点及失败风险因素。
回顾性分析2016年6月1日至2018年5月31日在北京大学生命科学学院人民医院外科重症监护病房（ICU）接受有创通气撤机后序贯HFNC治疗的患者。对临床变量、呼吸治疗参数、呼吸变量、心脏变量及转归进行回顾分析。分析撤机后HFNC的治疗特点。根据HFNC治疗失败情况将患者分为HFNC成功组和HFNC失败组，比较两组间差异。采用Logistic回归分析HFNC治疗失败的独立危险因素。通过受试者工作特征（ROC）曲线分析危险因素及回归模型对治疗失败的预测价值。
共纳入99例患者，男性61例，中位年龄67.0（57.0，76.0）岁。初始HFNC流量中位数为50（50，60）L/min，吸入氧浓度（FiO）为0.50（0.40，0.60）。18例患者出现HFNC治疗失败（18.2%）。与HFNC成功组相比，HFNC失败组序贯器官衰竭评估（SOFA）评分更高[4（3，5）比2（1，3），P<0.01]，HFNC治疗前B型利钠肽（BNP）显著更高[ng/L：647.2（399.2，1331.3）比127.2（55.2，369.5），P<0.01]，HFNC治疗30分钟后呼吸频率（RR）和心率（HR）显著更快，平均动脉压（MAP）显著更高，氧合指数（PaO/FiO）显著更低[RR（次/分）：26（22，28）比19（17，21），HR（次/分）：105（97，107）比85（77，90），MAP（mmHg，1mmHg = 0.133kPa）：104.3（101.7，110.7）比92.3（88.3，97.7），PaO/FiO（mmHg）：207.3（185.8，402.8）比320.2（226.2，361.5），均P<0.05]。多因素Logistic回归分析显示，SOFA评分[比值比（OR）=2.818，P = 0.022，β = 1.036]、HFNC治疗前BNP（OR = 1.002，P = 0.033，β = 0.002）及HFNC治疗30分钟后HR（OR = 1.140，P = 0.032，β = 0.131）是HFNC治疗失败的独立危险因素。ROC曲线显示，SOFA、HFNC治疗前BNP、HFNC治疗30分钟后HR及回归模型预测HFNC失败的ROC曲线下面积（AUC）分别为0.840、0.859、0.860和0.962，均具有良好的预测价值（均P<0.01）。
HFNC是ICU常用的氧疗方法之一，但并非所有有创机械通气撤机后序贯治疗的患者都能从中获益。SOFA评分、HFNC治疗前BNP及HFNC治疗30分钟后HR是HFNC失败的独立危险因素。各独立危险因素及回归模型均可预测HFNC治疗的成败。
