Institute of Intensive Care Medicine, University Hospital of Zurich, Zurich, Switzerland.
Intensive Care Department, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Spain.
Crit Care. 2022 Feb 8;26(1):37. doi: 10.1186/s13054-022-03905-5.
Non-invasive oxygenation strategies have a prominent role in the treatment of acute hypoxemic respiratory failure during the coronavirus disease 2019 (COVID-19). While the efficacy of these therapies has been studied in hospitalized patients with COVID-19, the clinical outcomes associated with oxygen masks, high-flow oxygen therapy by nasal cannula and non-invasive mechanical ventilation in critically ill intensive care unit (ICU) patients remain unclear.
In this retrospective study, we used the best of nine covariate balancing algorithms on all baseline covariates in critically ill COVID-19 patients supported with > 10 L of supplemental oxygen at one of the 26 participating ICUs in Catalonia, Spain, between March 14 and April 15, 2020.
Of the 1093 non-invasively oxygenated patients at ICU admission treated with one of the three stand-alone non-invasive oxygenation strategies, 897 (82%) required endotracheal intubation and 310 (28%) died during the ICU stay. High-flow oxygen therapy by nasal cannula (n = 439) and non-invasive mechanical ventilation (n = 101) were associated with a lower rate of endotracheal intubation (70% and 88%, respectively) than oxygen masks (n = 553 and 91% intubated), p < 0.001. Compared to oxygen masks, high-flow oxygen therapy by nasal cannula was associated with lower ICU mortality (hazard ratio 0.75 [95% CI 0.58-0.98), and the hazard ratio for ICU mortality was 1.21 [95% CI 0.80-1.83] for non-invasive mechanical ventilation.
In critically ill COVID-19 ICU patients and, in the absence of conclusive data, high-flow oxygen therapy by nasal cannula may be the approach of choice as the primary non-invasive oxygenation support strategy.
在 2019 年冠状病毒病（COVID-19）期间，非侵入性氧合策略在治疗急性低氧性呼吸衰竭方面具有重要作用。虽然这些治疗方法在 COVID-19 住院患者中已经进行了研究，但在危重症加强护理病房（ICU）患者中，与氧气面罩、鼻导管高流量氧疗和无创机械通气相关的临床结局仍不清楚。
在这项回顾性研究中，我们使用了最佳的九种协变量平衡算法，对西班牙加泰罗尼亚 26 家参与 ICU 中的所有 COVID-19 危重症患者的所有基线协变量进行了平衡，这些患者在 ICU 入住时需要补充超过 10 L 的氧气。
在接受三种独立非侵入性氧合策略之一治疗的 1093 名 ICU 入院时接受非侵入性氧合的患者中，897 例（82%）需要进行气管插管，310 例（28%）在 ICU 期间死亡。与氧气面罩（n=553 例，分别有 91%和 91%的患者需要插管）相比，鼻导管高流量氧疗（n=439 例）和无创机械通气（n=101 例）的插管率较低（分别为 70%和 88%），p<0.001。与氧气面罩相比，鼻导管高流量氧疗与较低的 ICU 死亡率相关（危险比 0.75[95%CI 0.58-0.98]），而无创机械通气的 ICU 死亡率危险比为 1.21[95%CI 0.80-1.83]。
在 COVID-19 危重症 ICU 患者中，在没有确凿数据的情况下，鼻导管高流量氧疗可能是首选的主要非侵入性氧合支持策略。
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