Dubie Elophe, Morin François, Savary Dominique, Serruys Amaury, Usseglio Pascal
Emergency Department, Metropole Savoie Hospital, BP 1125, 73000, Chambery, France.
Emergency Department, Angers University Hospital, Angers, France.
Int J Emerg Med. 2021 Sep 26;14(1):61. doi: 10.1186/s12245-021-00385-2.
At the start of the COVID-19 pandemic, early intubation was recommended on the basis of worldwide observations of severe hypoxemia. However, some patients were ultimately able to benefit from high-flow nasal cannula (HFNC) and thus avoid intubation. During the "second wave" (September to December 2020 in France), some emergency departments implemented HFNC in patients with severe COVID-19. The question then arose regarding the transfer of these most serious patients to intensive care units (ICU) and of the respiratory modalities to be used during this transfer. To assess the feasibility of interhospital transfers of COVID-19 patients needing HFNC, we conducted a bi-centric prospective observational study of all medical transfers of patients needing HFNC with the Chambéry and Angers (France) mobile emergency and intensive care service (SMUR) during the "second wave" of the COVID-19 pandemic in France. Analysis of these 42 patients showed no significant variation in the respiratory requirements during the transfer. Overall, 52% of patients were intubated during their stay in ICU, including three patients intubated before or during transfer. Interhospital transfer with HFNC is very high-risk, and intubation remains indicated in the most unstable patients. However, 48% of patients benefited from HFNC and were thus able to avoid intubation during their transfer and ICU stay; for these patients, intubation would probably have been indicated in the absence of available HFNC techniques.
在新冠疫情初期，基于全球范围内对严重低氧血症的观察结果，建议早期进行气管插管。然而，一些患者最终能够从高流量鼻导管吸氧（HFNC）中获益，从而避免了气管插管。在“第二波疫情”期间（2020年9月至12月在法国），一些急诊科对重症新冠患者实施了HFNC。随之而来的问题是，如何将这些病情最严重的患者转运至重症监护病房（ICU），以及在转运过程中应采用何种呼吸支持方式。为评估需要HFNC的新冠患者院间转运的可行性，我们在法国新冠疫情“第二波”期间，对尚贝里和昂热（法国）的移动急诊和重症监护服务（SMUR）所进行的所有需要HFNC的患者医疗转运开展了一项双中心前瞻性观察研究。对这42例患者的分析显示，转运过程中的呼吸需求无显著变化。总体而言，52%的患者在入住ICU期间接受了气管插管，其中包括3例在转运前或转运过程中插管的患者。使用HFNC进行院间转运风险极高，最不稳定的患者仍需进行气管插管。然而，48%的患者从HFNC中获益，从而在转运和ICU住院期间避免了气管插管；对于这些患者，如果没有可用的HFNC技术，可能会进行气管插管。
