高流量鼻导管治疗急性低氧性呼吸衰竭的疗效预测因素。
Predictors of success of high-flow nasal cannula in the treatment of acute hypoxemic respiratory failure.
机构信息
Servicio de Cuidados Críticos y Urgencias, Hospital de Montilla, Montilla, Córdoba, España; Servicio de Medicina Intensiva, Hospital Cruz Roja, Córdoba, España.
Emergency Assessment Unit, John Radcliffe, Oxford University Hospital, Oxford, Reino Unido.
出版信息
Med Intensiva (Engl Ed). 2021 Mar;45(2):80-87. doi: 10.1016/j.medin.2019.07.012. Epub 2019 Aug 24.
BACKGROUND
High-flow nasal cannula (HFNC) therapy is used in the treatment of acute respiratory failure (ARF) and is both safe and effective in reversing hypoxemia. In order to minimize mortality and clinical complications associated to this practice, a series of tools must be developed to allow early detection of failure. The present study was carried out to: (i)examine the impact of respiratory rate (RR), peripheral oxygen saturation (SpO), ROX index (ROXI=[SpO/FiO]/RR) and oxygen inspired fraction (FiO) on the success of HFNC in patients with hypoxemic ARF; and (ii)analyze the length of stay and mortality in the ICU, and the need for mechanical ventilation (MV).
METHODS
A retrospective study was carried out in the medical-surgical ICU of Hospital de Montilla (Córdoba, Spain). Patients diagnosed with hypoxemic ARF and treated with HFNC from January 2016 to January 2018 were included.
RESULTS
Out of 27 patients diagnosed with ARF, 19 (70.37%) had hypoxemic ARF. Fifteen of them (78.95%) responded satisfactorily to HFNC, while four (21.05%) failed. After two hours of treatment, RR proved to be the best predictor of success (area under the ROC curve [AUROC] 0.858; 95%CI: 0.63-1.05; P=.035). For this parameter, the optimal cutoff point was 29rpm (sensitivity 75%, specificity 87%). After 8hours of treatment, FiO and ROXI were reliable predictors of success (FiO: AUROC 0.95; 95%CI: 0.85-1.04; P=.007 and ROXI: AUROC 0.967; 95%CI: 0.886-1.047; P=.005). In the case of FiO the optimal cutoff point was 0.59 (sensitivity 75%, specificity 93%), while the best cutoff point for ROXI was 5.98 (sensitivity 100%, specificity 75%). Using a Cox regression model, we found RR<29rpm after two hours of treatment, and FiO<0.59 and ROXI>5.98 after 8hours of treatment, to be associated with a lesser risk of MV (RR: HR 0.103; 95%CI: 0.11-0.99; P=.05; FiO: HR 0.053; 95%CI: 0.005-0.52; P=.012; and ROXI: HR 0.077; 95%CI: 0.008-0.755; P=.028, respectively).
CONCLUSIONS
RR after two hours of treatment, and FiO and ROXI after 8hours of treatment, were the best predictors of success of HFNC. RR<29rpm, FiO<0.59 and ROXI>5.98 were associated with a lesser risk of MV.
背景
高流量鼻导管（HFNC）治疗用于治疗急性呼吸衰竭（ARF），在逆转低氧血症方面既安全又有效。为了最大程度地降低与该治疗相关的死亡率和临床并发症，必须开发一系列工具以实现早期检测失败。本研究旨在：（i）检查呼吸频率（RR）、外周血氧饱和度（SpO）、ROX 指数（ROXI=[SpO/FiO]/RR）和吸入氧气分数（FiO）对低氧性 ARF 患者 HFNC 成功的影响；和（ii）分析 ICU 住院时间和死亡率以及对机械通气（MV）的需求。
方法
在西班牙科尔多瓦的蒙蒂利亚（Montilla）医院的内科和外科 ICU 进行了回顾性研究。纳入 2016 年 1 月至 2018 年 1 月期间被诊断为低氧性 ARF 并接受 HFNC 治疗的患者。
结果
在 27 名被诊断为 ARF 的患者中，有 19 名（70.37%）患有低氧性 ARF。其中 15 名（78.95%）对 HFNC 治疗有满意反应，而 4 名（21.05%）治疗失败。治疗 2 小时后，RR 被证明是成功的最佳预测因子（ROC 曲线下面积 [AUROC] 0.858；95%CI：0.63-1.05；P=.035）。对于该参数，最佳截断点为 29rpm（灵敏度 75%，特异性 87%）。治疗 8 小时后，FiO 和 ROXI 是成功的可靠预测因子（FiO：AUROC 0.95；95%CI：0.85-1.04；P=.007 和 ROXI：AUROC 0.967；95%CI：0.886-1.047；P=.005）。对于 FiO，最佳截断点为 0.59（灵敏度 75%，特异性 93%），而 ROXI 的最佳截断点为 5.98（灵敏度 100%，特异性 75%）。使用 Cox 回归模型，我们发现治疗 2 小时后 RR<29rpm，治疗 8 小时后 FiO<0.59 和 ROXI>5.98 与 MV 风险降低相关（RR：HR 0.103；95%CI：0.11-0.99；P=.05；FiO：HR 0.053；95%CI：0.005-0.52；P=.012；和 ROXI：HR 0.077；95%CI：0.008-0.755；P=.028）。
结论
治疗 2 小时后的 RR，以及治疗 8 小时后的 FiO 和 ROXI，是 HFNC 成功的最佳预测因子。RR<29rpm、FiO<0.59 和 ROXI>5.98 与 MV 风险降低相关。
Zotero 插件