Duan Jun, Zeng Jia, Deng Puyu, Ni Zhong, Lu Rongli, Xia Wenxi, Jing Guoqiang, Su Xiaoping, Ehrmann Stephan, Zhang Wei, Li Jie
Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Department of Aviation Disease, Naval Medical Center of PLA, Second Military Medical University, Shanghai, China.
Front Mol Biosci. 2021 Apr 13;8:639100. doi: 10.3389/fmolb.2021.639100. eCollection 2021.
High-flow nasal cannula (HFNC) may help avoid intubation of hypoxemic patients suffering from COVID-19; however, it may also contribute to delaying intubation, which may increase mortality. Here, we aimed to identify the predictors of HFNC failure among patients with COVID-19. We performed a multicenter retrospective study in China from January 15 to March 31, 2020. Two centers in Wuhan (resource-limited centers) enrolled 32 patients, and four centers outside Wuhan enrolled 34 cases. HFNC failure was defined as the requirement of escalation therapy (NIV or intubation). The ROX index (the ratio of SpO/FiO to the respiratory rate) was calculated. Among the 66 patients, 29 (44%) cases experienced HFNC failure. The ROX index was much lower in failing patients than in successful ones after 1, 2, 4, 8, 12, and 24 h of HFNC. The ROX index was independently associated with HFNC failure (OR = 0.65; 95% CI: 0.45-0.94) among the variables collected before and 1 h after HFNC. To predict HFNC failure tested by ROX index, the AUC was between 0.73 and 0.79 for the time points of measurement 1-24 h after HFNC initiation. The HFNC failure rate was not different between patients in and outside Wuhan (41% vs. 47%, = 0.63). However, the time from HFNC initiation to intubation was longer in Wuhan than that outside Wuhan (median 63 vs. 22 h, = 0.02). Four patients in Wuhan underwent intubation due to cardiac arrest; in contrast, none of the patients outside Wuhan received intubation (13 vs. 0%, = 0.05). The mortality was higher in Wuhan than that out of Wuhan, but the difference did not reach statistical significance (31 vs. 12%, = 0.07). The ROX index can be used to predict HFNC failure among COVID-19 patients to avoid delayed intubation, which may occur in the resource-limited area.
高流量鼻导管（HFNC）可能有助于避免对感染新型冠状病毒肺炎的低氧血症患者进行气管插管；然而，它也可能导致气管插管延迟，进而可能增加死亡率。在此，我们旨在确定新型冠状病毒肺炎患者中HFNC失败的预测因素。我们于2020年1月15日至3月31日在中国进行了一项多中心回顾性研究。武汉的两个中心（资源有限的中心）纳入了32例患者，武汉以外的四个中心纳入了34例。HFNC失败定义为需要升级治疗（无创通气或气管插管）。计算ROX指数（血氧饱和度/吸入氧浓度与呼吸频率之比）。在这66例患者中，29例（44%）出现HFNC失败。HFNC治疗1、2、4、8、12和24小时后，失败患者的ROX指数远低于成功患者。在HFNC治疗前及治疗后1小时收集的变量中，ROX指数与HFNC失败独立相关（比值比=0.65；95%置信区间：0.45-0.94）。以ROX指数测试预测HFNC失败，在HFNC开始后1-24小时的测量时间点，曲线下面积在0.73至0.79之间。武汉地区和非武汉地区患者的HFNC失败率无差异（41%对47%，P=0.63）。然而，武汉地区从HFNC开始到气管插管的时间比非武汉地区更长（中位数63小时对22小时，P=0.02）。武汉有4例患者因心脏骤停接受气管插管；相比之下，非武汉地区无一例患者接受气管插管（13%对0%，P=0.05）。武汉地区的死亡率高于非武汉地区，但差异未达到统计学意义（31%对12%，P=0.07）。ROX指数可用于预测新型冠状病毒肺炎患者的HFNC失败，以避免在资源有限地区可能出现的气管插管延迟。
