Division of Pulmonary, Critical Care and Sleep Medicine, Medstar Georgetown University Hospital, Washington DC.
Respir Care. 2021 Apr;66(4):566-572. doi: 10.4187/respcare.07688. Epub 2020 Oct 19.
High-flow nasal cannula (HFNC) has gained widespread use for acute hypoxemic respiratory failure on the basis of recent publications that demonstrated fewer intubations and perhaps lower mortality in certain situations. However, a subset of patients initiated on HFNC for respiratory failure ultimately do require intubation. Our goal was to identify patient-level features predictive of this outcome.
This was a retrospective cohort study of subjects with hypoxemic respiratory failure treated with HFNC. Individuals were described as having succeeded (if weaned from HFNC) or failed (if they required intubation). A variety of easily measurable variables were evaluated for their ability to predict intubation risk, analyzed via a multivariate logistic regression model.
Of a total of 74 subjects, 42 succeeded and 32 failed. The mean ± SD net fluid balance in the first 24 h after HFNC initiation was significantly lower in the success group versus the failure group (-33 ± 80 mL/h vs 72 ± 117 mL/h; < .01). An adjusted model found only fluid balance and the previously described respiratory rate (breathing frequency [f]) to oxygenation (ROX) index ([[Formula: see text]/[Formula: see text]]/f) at 12 h as significant predictors of successful weaning (negative fluid balance adjusted odds ratio 0.77 [95% CI 0.62-0.96] for -10 mL/h increments [ = .02]; ROX adjusted OR 1.72 [1.15-2.57], < .01).
A negative fluid balance while on HFNC discriminated well between those who required intubation versus those who were successfully weaned.
高流量鼻导管（HFNC）在最近的一些出版物中得到了广泛应用，这些出版物表明在某些情况下，HFNC 可减少插管的需求，并且可能降低死亡率，因此用于治疗急性低氧性呼吸衰竭。然而，有一部分接受 HFNC 治疗的呼吸衰竭患者最终需要插管。我们的目标是确定可预测这一结果的患者个体特征。
这是一项回顾性队列研究，纳入了接受 HFNC 治疗的低氧性呼吸衰竭患者。根据患者是否成功（从 HFNC 成功撤机）或失败（需要插管）进行分组。通过多变量逻辑回归模型，评估了多种易于测量的变量对插管风险的预测能力。
在总共 74 名患者中，有 42 名成功，32 名失败。HFNC 治疗开始后 24 小时内的净液体平衡在成功组与失败组之间差异有统计学意义（-33 ± 80 毫升/小时对 72 ± 117 毫升/小时； <.01）。调整后的模型仅发现液体平衡和之前描述的呼吸频率（f）与氧合指数（ROX）在 12 小时时是成功撤机的显著预测因素（负液体平衡调整后比值比 0.77[95%CI 0.62-0.96]，每减少 10 毫升/小时[ =.02]；ROX 调整后比值比 1.72[1.15-2.57]， <.01）。
HFNC 期间的负液体平衡可很好地区分需要插管和成功撤机的患者。
