Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA.
Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA.
Crit Care Med. 2020 Nov;48(11):e1045-e1053. doi: 10.1097/CCM.0000000000004600.
Increasing time to mechanical ventilation and high-flow nasal cannula use may be associated with mortality in coronavirus disease 2019. We examined the impact of time to intubation and use of high-flow nasal cannula on clinical outcomes in patients with coronavirus disease 2019.
Retrospective cohort study.
Six coronavirus disease 2019-specific ICUs across four university-affiliated hospitals in Atlanta, Georgia.
Adults with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection who received high-flow nasal cannula or mechanical ventilation.
None.
Among 231 patients admitted to the ICU, 109 (47.2%) were treated with high-flow nasal cannula and 97 (42.0%) were intubated without preceding high-flow nasal cannula use. Of those managed with high-flow nasal cannula, 78 (71.6%) ultimately received mechanical ventilation. In total, 175 patients received mechanical ventilation; 44.6% were female, 66.3% were Black, and the median age was 66 years (interquartile range, 56-75 yr). Seventy-six patients (43.4%) were intubated within 8 hours of ICU admission, 57 (32.6%) between 8 and 24 hours of admission, and 42 (24.0%) greater than or equal to 24 hours after admission. Patients intubated within 8 hours were more likely to have diabetes, chronic comorbidities, and higher admission Sequential Organ Failure Assessment scores. Mortality did not differ by time to intubation (≤ 8 hr: 38.2%; 8-24 hr: 31.6%; ≥ 24 hr: 38.1%; p = 0.7), and there was no association between time to intubation and mortality in adjusted analysis. Similarly, there was no difference in initial static compliance, duration of mechanical ventilation, or ICU length of stay by timing of intubation. High-flow nasal cannula use prior to intubation was not associated with mortality.
In this cohort of critically ill patients with coronavirus disease 2019, neither time from ICU admission to intubation nor high-flow nasal cannula use were associated with increased mortality. This study provides evidence that coronavirus disease 2019 respiratory failure can be managed similarly to hypoxic respiratory failure of other etiologies.
机械通气和高流量鼻导管使用时间的延长可能与 2019 年冠状病毒病（COVID-19）患者的死亡率相关。我们研究了 COVID-19 患者插管时间和高流量鼻导管使用对临床结局的影响。
回顾性队列研究。
佐治亚州亚特兰大的四家大学附属医院的 6 个 COVID-19 特定 ICU。
接受高流量鼻导管或机械通气治疗的实验室确诊的严重急性呼吸综合征冠状病毒 2 感染的成人。
无。
在 231 名入住 ICU 的患者中，109 名（47.2%）接受了高流量鼻导管治疗，97 名（42.0%）在未使用高流量鼻导管之前进行了插管。在接受高流量鼻导管治疗的患者中，最终有 78 名（71.6%）接受了机械通气。总共 175 名患者接受了机械通气；44.6%为女性，66.3%为黑人，中位年龄为 66 岁（四分位距，56-75 岁）。76 名（43.4%）患者在 ICU 入院后 8 小时内插管，57 名（32.6%）在入院后 8-24 小时内插管，42 名（24.0%）在入院后大于或等于 24 小时内插管。8 小时内插管的患者更有可能患有糖尿病、慢性合并症和更高的入院序贯器官衰竭评估评分。按插管时间划分，死亡率无差异（≤8 小时：38.2%；8-24 小时：31.6%；≥24 小时：38.1%；p=0.7），调整分析中插管时间与死亡率之间也没有关联。同样，按插管时间划分，初始静态顺应性、机械通气持续时间或 ICU 住院时间无差异。在插管前使用高流量鼻导管与死亡率无关。
在本队列中，COVID-19 危重症患者中，从 ICU 入院到插管的时间或高流量鼻导管的使用均与死亡率增加无关。这项研究提供了证据表明，COVID-19 呼吸衰竭可以与其他病因导致的低氧性呼吸衰竭类似地进行管理。
