Zhou Aiyuan, Song Qing, Peng Yating, Deng Dingding, Liao Xin, Huang Peng, Liu Wenlong, Xiang Zhi, Liu Qimi, Jiang Mingyan, Huang Xiaoying, Xiang Xudong, Peng Hong, Chen Ping
Department of Respiratory and Critical Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China.
Department of Respiratory and Critical Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, 410011, China.
Int J Gen Med. 2021 Sep 28;14:6085-6092. doi: 10.2147/IJGM.S327429. eCollection 2021.
Oxygen therapy (OT) is the most widely used supportive regime in patients with hypoxemic acute respiratory failure (ARF) due to severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection. The aim of this study was to identify the effect of noninvasive ventilation support on coronavirus disease 2019 (COVID-19) patients and risk factors for invasive mechanical ventilation (IMV).
We retrospectively analyzed confirmed COVID-19 subjects from nine hospitals outside Wuhan. All hospitalized patients who tested positive for COVID-19 by real-time polymerase chain reaction between January 1st and March 31st, 2020, were recruited. The patients were divided into four groups based on the most advanced OT regime, including no OT, nasal oxygen therapy, high-flow nasal oxygen therapy (HFNOT) or noninvasive ventilation (NIV), and IMV. Multiple logistic regression models were performed to determine risk factors for IMV.
Of the 683 recruited subjects, 315 (46.1%) subjects did not need OT, 300 (43.9%) received nasal oxygen therapy, 51 (7.5%) received HFNOT or NIV, while 17 (2.5%) subjects had to be intubated. The lactate in the OT group was higher than in the no OT group (2.7 vs 1.6, = 0.02). In addition, HFNOT or NIV patients had a higher respiratory rate, but a lower PaO2 ( < 0.001). HFNOT and NIV had an obvious beneficial effect on ARF with 75% of COVID-19 patients recovering from respiratory failure. Patients with IMV were older ( < 0.001), had a higher rate of hypertension ( < 0.001) and more secondary bacterial infections ( < 0.001) compared to those without intubation. The multivariate model showed that secondary bacterial infection (OR = 6.87, = 0.009) was independently associated with IMV failure among COVID-19 patients.
We identified that HFNOT and NIV had an obvious beneficial effect on ARF among COVID-19 patients. We also demonstrated that secondary bacterial infection was an independent risk factor for NIV failure in patients infected by SARS-COV2.
氧疗（OT）是因严重急性呼吸综合征冠状病毒（SARS-CoV-2）感染导致的低氧血症急性呼吸衰竭（ARF）患者中使用最广泛的支持治疗方案。本研究的目的是确定无创通气支持对2019冠状病毒病（COVID-19）患者的影响以及有创机械通气（IMV）的危险因素。
我们回顾性分析了武汉以外九家医院确诊的COVID-19患者。招募了2020年1月1日至3月31日期间通过实时聚合酶链反应检测COVID-19呈阳性的所有住院患者。根据最先进的氧疗方案将患者分为四组，包括不进行氧疗、鼻导管给氧、高流量鼻导管给氧（HFNOT）或无创通气（NIV）以及有创机械通气。进行多因素逻辑回归模型以确定有创机械通气的危险因素。
在招募的683名受试者中，315名（46.1%）受试者不需要氧疗；300名（43.9%）接受鼻导管给氧；51名（7.5%）接受高流量鼻导管给氧或无创通气，而17名（2.5%）受试者必须进行插管。氧疗组的乳酸水平高于非氧疗组（2.7对1.6，P = 0.02）。此外，接受高流量鼻导管给氧或无创通气的患者呼吸频率更高，但动脉血氧分压更低（P < 0.001）。高流量鼻导管给氧和无创通气对急性呼吸衰竭有明显的有益作用，75%的COVID-19患者从呼吸衰竭中康复。与未插管的患者相比，接受有创机械通气的患者年龄更大（P < 0.001）、高血压发生率更高（P < 0.001）且继发性细菌感染更多（P < 0.001）。多因素模型显示，继发性细菌感染（比值比 = 6.87，P = 0.009）与COVID-19患者有创机械通气失败独立相关。
我们发现高流量鼻导管给氧和无创通气对COVID-19患者的急性呼吸衰竭有明显的有益作用。我们还证明继发性细菌感染是SARS-CoV-2感染患者无创通气失败的独立危险因素。
