San José Hospital, 42709Fundación Universitaria De Ciencias de la Salud (FUCS), CIMCA research group, Bogotá, Colombia.
Critical Care Pediatric Unit, Ethics Committee, Hospital San José, Bogotá, Colombia.
J Intensive Care Med. 2022 Sep;37(9):1199-1205. doi: 10.1177/08850666211057503. Epub 2021 Nov 23.
The use of high-flow nasal cannulas (HFNC) in patients with hypoxemic ventilatory failure reduces the need for mechanical ventilation and does not increase mortality when intubation is promptly applied. The aim of the study is to describe the behavior of HFNC in patients who live at high altitudes, and the performance of predictors of success/failure of this strategy. Prospective multicenter cohort study, with patients aged over 18 years recruited for 12 months in 2020 to 21. All had a diagnosis of hypoxemic respiratory failure secondary to pneumonia, were admitted to intensive care units, and were receiving initial management with a high-flow nasal cannula. The variables assessed included need for intubation, mortality in ICU, and the validation of SaO2, respiratory rate (RR) and ROX index (IROX) as predictors of HFNC success / failure. One hundred and six patients were recruited, with a mean age of 59 years and a success rate of 74.5%. Patients with treatment failure were more likely to be obese (BMI 27.2 vs 25.5; OR: 1.03; 95% CI: .95-1.1) and had higher severity scores at admission (APACHE II 12 vs 20; OR 1.15; 95% CI: 1.06-1.24). Respiratory rates after 12 (AUC .81 CI: .70-.92) and 18 h (AUC .85 CI: .72-0.90) of HFNC use were the best predictors of failure, performing better than those that included oxygenation. ICU mortality was higher in the failure group (6% vs 29%; OR 8.8; 95% CI:1.75-44.7). High-flow oxygen cannula therapy in patients with hypoxemic respiratory failure living at altitudes above 2600 m is associated with low rates of therapy failure and a reduced need for mechanical ventilation in the ICU. The geographical conditions and secondary physiological changes influence the performance of the traditionally validated predictors of therapy success. Respiratory rate <30 proved to be the best indicator of early success of the device at 12 h of use.
高流量鼻导管（HFNC）在低氧性通气衰竭患者中的应用可减少机械通气的需求，并且当及时插管时不会增加死亡率。本研究的目的是描述在高海拔地区患者中 HFNC 的使用情况，以及该策略成功/失败的预测因素的表现。 前瞻性多中心队列研究，2020 年至 2021 年期间招募了 18 岁以上的患者，共 12 个月。所有患者均因肺炎继发低氧性呼吸衰竭，收入重症监护病房，并接受高流量鼻导管初始治疗。评估的变量包括插管需求、重症监护病房死亡率，以及 SaO2、呼吸频率（RR）和 ROX 指数（IROX）作为 HFNC 成功/失败预测因素的验证。 共纳入 106 例患者，平均年龄 59 岁，成功率为 74.5%。治疗失败的患者更可能肥胖（BMI 27.2 比 25.5；OR：1.03；95%CI：.95-1.1），入院时严重程度评分更高（APACHE II 12 比 20；OR 1.15；95%CI：1.06-1.24）。HFNC 使用 12 小时（AUC.81 CI：.70-.92）和 18 小时（AUC.85 CI：.72-0.90）后呼吸频率是失败的最佳预测因素，优于那些包括氧合的预测因素。失败组 ICU 死亡率较高（6%比 29%；OR 8.8；95%CI：1.75-44.7）。 在海拔 2600 米以上的低氧性呼吸衰竭患者中应用高流量氧鼻导管治疗与治疗失败率低和 ICU 机械通气需求减少相关。地理条件和继发性生理变化影响治疗成功的传统验证预测因素的性能。在使用 12 小时时，<30 次/分的呼吸频率被证明是该设备早期成功的最佳指标。
