高流量鼻导管治疗新型冠状病毒肺炎低氧血症呼吸衰竭患者
High-flow nasal cannula therapy for hypoxemic respiratory failure in patients with COVID-19.
作者信息
Chavarria Adrian Palacios, Lezama Erika Salinas, Navarro Mauricio Gonzalez, Vazquez Rafael Ricardo Valdez, Bello Héctor Herrera, Gascon Julieta Lomelín, Juárez Linda Morales, Avendaño Mónica Arboleya, Gonzalez Luis Esteban Ramirez, Ville Benavides Rodrigo, Wyssmann Renate Victoria Álvarez, Ortiz Brenda Sandoval, de la Cerda Mariana Lizbeth Rodríguez, Castañeda Lidia Moreno, Martinez-Juarez Luis Alberto, Gallardo-Rincón Héctor, Tapia-Conyer Roberto
机构信息
Temporary COVID-19 Hospital, Hipódromo de las Américas, Miguel Hidalgo, Mexico City, Mexico.
Fundación Carlos Slim, Miguel Hidalgo, Mexico City, Mexico.
出版信息
Ther Adv Infect Dis. 2021 Sep 3;8:20499361211042959. doi: 10.1177/20499361211042959. eCollection 2021 Jan-Dec.
INTRODUCTION
High-flow nasal cannula (HFNC) therapy in patients with hypoxemic respiratory failure due to COVID-19 is poorly understood and remains controversial.
METHODS
We evaluated a large cohort of patients with COVID-19-related hypoxemic respiratory failure at the temporary COVID-19 hospital in Mexico City. The primary outcome was the success rate of HFNC to prevent the progression to invasive mechanical ventilation (IMV). We also evaluated the risk factors associated with HFNC success or failure.
RESULTS
HFNC use effectively prevented IMV in 71.4% of patients [270 of 378 patients; 95% confidence interval (CI) 66.6-75.8%]. Factors that were significantly different at admission included age, the presence of hypertension, and the Charlson comorbidity index. Predictors of therapy failure (adjusted hazard ratio, 95% CI) included the comorbidity-age-lymphocyte count-lactate dehydrogenase (CALL) score at admission (1.27, 1.09-1.47; < 0.01), Rox index at 1 hour (0.82, 0.7-0.96; = 0.02), and no prior steroid treatment (0.34, 95% CI 0.19-0.62; < 0.0001). Patients with HFNC success rarely required admission to the intensive care unit and had shorter lengths of hospital stay [19/270 (7.0%) and 15.0 (interquartile range, 11-20) days, respectively] than those who required IMV [104/108 (96.3%) and 26.5 (20-36) days, respectively].
CONCLUSION
Treating patients with HFNC at admission led to improvement in respiratory parameters in many patients with COVID-19.
引言
对于新型冠状病毒肺炎（COVID-19）所致低氧性呼吸衰竭患者，高流量鼻导管（HFNC）治疗的了解较少且仍存在争议。
方法
我们在墨西哥城的临时COVID-19医院评估了一大群COVID-19相关低氧性呼吸衰竭患者。主要结局是HFNC预防进展为有创机械通气（IMV）的成功率。我们还评估了与HFNC成功或失败相关的危险因素。
结果
HFNC有效预防了71.4%的患者发生IMV[378例患者中的270例；95%置信区间（CI）66.6-75.8%]。入院时显著不同的因素包括年龄、高血压的存在以及Charlson合并症指数。治疗失败的预测因素（调整后的风险比，95%CI）包括入院时的合并症-年龄-淋巴细胞计数-乳酸脱氢酶（CALL）评分（1.27，1.09-1.47；P<0.01）、1小时时的罗克斯指数（0.82，0.7-0.96；P=0.02）以及未接受过类固醇治疗（0.34，95%CI 0.19-0.62；P<0.0001）。HFNC治疗成功的患者很少需要入住重症监护病房，住院时间也比需要IMV的患者短[分别为19/270（7.0%）和15.0（四分位间距，11-20）天]，而需要IMV的患者分别为104/108（96.3%）和26.5（20-36）天。
结论
入院时用HFNC治疗可使许多COVID-19患者的呼吸参数得到改善。
Zotero 插件