Rorat Marta, Szymański Wojciech, Jurek Tomasz, Karczewski Maciej, Zelig Jakub, Simon Krzysztof
Department of Forensic Medicine, Wroclaw Medical University, 50-367 Wroclaw, Poland.
Department of Infectious Diseases and Hepatology, Wroclaw Medical University, 50-367 Wroclaw, Poland.
J Clin Med. 2021 Oct 16;10(20):4751. doi: 10.3390/jcm10204751.
High-flow nasal oxygen (HFNO) is recommended as a first-line treatment in patients with acute hypoxemic respiratory failure due to COVID-19. We assessed the effectiveness of HFNO and predictors of failure and death. The medical records of 200 consecutive adult patients treated with HFNO were analysed. Ninety-two patients (46%) were successfully cured, 52 (26%) required noninvasive ventilation, and 61 (30.5%) received intubation. Overall mortality was 40.5%. Risk factors of HFNO ineffectiveness were: SpO ≤ 90% with conventional oxygen therapy (HR 0.32, 95% CI 0.19-0.53, < 0.001), SpO ≤ 74% without oxygen therapy (HR 0.44, 95% CI 0.27-0.71, < 0.001), an age ≥ 60, comorbidities, biomarkers (C-reactive protein, procalcitonin, creatinine, lactate dehydrogenase), duration of symptoms before admission to hospital ≤ 9 days, start of treatment with HFNO ≤ 4 days. The multivariate logistic regression models (age ≥ 60, comorbidities, C-reactive protein concentration and SpO with oxygen therapy) revealed a high predictive value of death and HFNO failure (AUC 0.851, sensitivity 0.780, specificity 0.802; AUC 0.800, sensitivity 0.776, specificity 0.739, respectively). HFNO is a safe method for treating acute hypoxemic respiratory failure, with effectiveness reaching nearly 50%. Low values of SpO without and during oxygen therapy seem to be good diagnostic tools for predicting death and HFNO failure.
对于因新型冠状病毒肺炎（COVID-19）导致的急性低氧性呼吸衰竭患者，高流量鼻导管给氧（HFNO）被推荐作为一线治疗方法。我们评估了HFNO的有效性以及失败和死亡的预测因素。分析了连续200例接受HFNO治疗的成年患者的病历。92例患者（46%）成功治愈，52例（26%）需要无创通气，61例（30.5%）接受了气管插管。总死亡率为40.5%。HFNO无效的危险因素包括：常规氧疗时SpO₂≤90%（HR 0.32，95%CI 0.19 - 0.53，P<0.001），未吸氧时SpO₂≤74%（HR 0.44，95%CI 0.27 - 0.71，P<0.001），年龄≥60岁，合并症，生物标志物（C反应蛋白、降钙素原、肌酐、乳酸脱氢酶），入院前症状持续时间≤9天，开始HFNO治疗≤4天。多因素逻辑回归模型（年龄≥60岁、合并症、C反应蛋白浓度和吸氧时的SpO₂）显示对死亡和HFNO失败具有较高的预测价值（AUC分别为0.851、敏感性0.780、特异性0.802；AUC为0.800、敏感性0.776、特异性0.739）。HFNO是治疗急性低氧性呼吸衰竭的一种安全方法，有效性接近50%。未吸氧和吸氧过程中SpO₂的低值似乎是预测死亡和HFNO失败的良好诊断工具。
