Department of Emergency, Intensive Care Medicine and Anesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS; Rome, Italy.
Department of Anesthesiology and Intensive Care Medicine, Catholic University of The Sacred Heart; Rome, Italy.
Respir Care. 2021 May;66(5):705-714. doi: 10.4187/respcare.08622. Epub 2021 Mar 2.
The efficacy of noninvasive oxygenation strategies (NIOS) in treating COVID-19 disease is unknown. We conducted a prospective observational study to assess the rate of NIOS failure in subjects treated in the ICU for hypoxemic respiratory failure due to COVID-19.
Patients receiving first-line treatment NIOS for hypoxemic respiratory failure due to COVID-19 in the ICU of a university hospital were included in this study; laboratory data were collected upon arrival, and 28-d outcome was recorded. After propensity score matching based on Simplified Acute Physiology (SAPS) II score, age, [Formula: see text] and [Formula: see text] at arrival, the NIOS failure rate in subjects with COVID-19 was compared to a previously published cohort who received NIOS during hypoxemic respiratory failure due to other causes.
A total of 85 subjects received first-line treatment with NIOS. The most frequently used methods were helmet noninvasive ventilation and high-flow nasal cannula; of these, 52 subjects (61%) required endotracheal intubation. Independent factors associated with NIOS failure were SAPS II score ( = .009) and serum lactate dehydrogenase at enrollment ( = .02); the combination of SAPS II score ≥ 33 with serum lactate dehydrogenase ≥ 405 units/L at ICU admission had 91% specificity in predicting the need for endotracheal intubation. In the propensity-matched cohorts (54 pairs), subjects with COVID-19 showed higher risk of NIOS failure than those with other causes of hypoxemic respiratory failure (59% vs 35%, = .02), with an adjusted hazard ratio of 2 (95% CI 1.1-3.6, = .01).
As compared to hypoxemic respiratory failure due to other etiologies, subjects with COVID-19 who were treated with NIOS in the ICU were burdened by a 2-fold higher risk of failure. Subjects with a SAPS II score ≥ 33 and serum lactate dehydrogenase ≥ 405 units/L represent the population with the greatest risk.
目前尚不清楚无创氧合策略（NIOS）在治疗 COVID-19 疾病中的疗效。我们进行了一项前瞻性观察性研究，以评估在 ICU 接受治疗的因 COVID-19 导致低氧性呼吸衰竭的患者中 NIOS 治疗失败的发生率。
本研究纳入了在一所大学医院的 ICU 中接受一线 NIOS 治疗因 COVID-19 导致低氧性呼吸衰竭的患者；收集入院时的实验室数据，并记录 28 天的结局。在基于简化急性生理学评分（SAPS）II 评分、年龄、[Formula: see text]和[Formula: see text]的倾向评分匹配后，比较 COVID-19 患者的 NIOS 失败率与先前发表的接受因其他原因导致低氧性呼吸衰竭时接受 NIOS 治疗的患者的 NIOS 失败率。
共有 85 例患者接受一线 NIOS 治疗。最常使用的方法是头盔无创通气和高流量鼻导管；其中 52 例（61%）需要气管插管。与 NIOS 失败相关的独立因素是 SAPS II 评分（ =.009）和入院时血清乳酸脱氢酶（ =.02）；SAPS II 评分≥33 与 ICU 入院时血清乳酸脱氢酶≥405 单位/L 的组合对预测气管插管的需求具有 91%的特异性。在匹配的倾向评分队列中（54 对），COVID-19 患者 NIOS 失败的风险高于其他低氧性呼吸衰竭病因的患者（59%比 35%， =.02），调整后的危险比为 2（95%CI 1.1-3.6， =.01）。
与其他病因导致的低氧性呼吸衰竭相比，在 ICU 接受 NIOS 治疗的 COVID-19 患者的 NIOS 治疗失败风险增加了 2 倍。SAPS II 评分≥33 和血清乳酸脱氢酶≥405 单位/L 的患者代表风险最大的人群。
