Intensive Care Unit, Saint-Antoine Hospital, Paris, France -
Assistance Publique-Hôpitaux de Paris, Paris, France -
Minerva Anestesiol. 2022 Jul-Aug;88(7-8):580-587. doi: 10.23736/S0375-9393.22.16094-3. Epub 2022 Feb 22.
SARS-CoV-2 pneumonia is responsible for unprecedented numbers of acute respiratory failure requiring invasive mechanical ventilation (IMV). This work aimed to assess whether adding face-mask noninvasive ventilation (NIV) to high-flow nasal oxygen (HFNO) was associated with a reduced need for endotracheal intubation.
This retrospective cohort study was conducted from July 2020 to January 2021 in two tertiary care intensive care units (ICUs) in Paris, France. Patients admitted for laboratory confirmed SARS-CoV-2 infection with acute hypoxemic respiratory failure requiring HFNO with or without NIV were included. The primary outcome was the rate of endotracheal intubation. Secondary outcomes included day-28 mortality, day-28 respiratory support and IMV free days, ICU and hospital length-of-stay. Sensitivity analyses with both propensity score matching and overlap weighting were used.
One hundred twenty-eight patients were included, 88 (69%) received HFNO alone and 40 (31%) received additional NIV. Additional NIV was associated with a reduced rate of endotracheal intubation in multivariate analysis (53 [60%] vs. 15 [38%], HR=0.46 [95% CI: 0.23-0.95], P=0.04). Sensitivity analyses by propensity score matching (HR=0.45 [95% CI: 0.24-0.84], P=0.01) and overlap weighting (HR=0.52 [95% CI: 0.28-0.94], P=0.03) were consistent. Day-28 mortality was 25 (28%) in the HFNO group and 8 (20%) in the NIV group (HR=0.75 [95% CI: 0.15-3.82], P=0.72). NIV was associated with higher IMV free days (20 [0-28] vs. 28 [14-28], P=0.015). All sensitivity analyses were consistent regarding secondary outcomes.
Need for endotracheal intubation was lower in critically-ill SARS-CoV-2 patients receiving face-mask noninvasive mechanical ventilation in addition to high-flow oxygen therapy.
SARS-CoV-2 肺炎导致需要进行有创机械通气（IMV）的急性呼吸衰竭患者数量空前。本研究旨在评估面罩无创通气（NIV）联合高流量鼻氧（HFNO）是否可降低气管插管的需求。
这是一项回顾性队列研究，于 2020 年 7 月至 2021 年 1 月在法国巴黎的两家三级护理重症监护病房（ICU）进行。纳入因实验室确诊的 SARS-CoV-2 感染而导致急性低氧性呼吸衰竭、需要 HFNO 联合或不联合 NIV 治疗的患者。主要结局为气管插管率。次要结局包括 28 天死亡率、28 天呼吸支持和 IMV 无天数、ICU 和住院时间。采用倾向评分匹配和重叠加权进行敏感性分析。
共纳入 128 例患者，88 例（69%）仅接受 HFNO 治疗，40 例（31%）接受额外的 NIV。多变量分析显示，NIV 组气管插管率较低（53[60%]例 vs. 15[38%]例，HR=0.46[95%CI：0.23-0.95]，P=0.04）。倾向评分匹配（HR=0.45[95%CI：0.24-0.84]，P=0.01）和重叠加权（HR=0.52[95%CI：0.28-0.94]，P=0.03）的敏感性分析结果一致。HFNO 组 28 天死亡率为 25（28%），NIV 组为 8（20%）（HR=0.75[95%CI：0.15-3.82]，P=0.72）。NIV 组 IMV 无天数更长（20[0-28] vs. 28[14-28]，P=0.015）。所有次要结局的敏感性分析结果均一致。
在接受高流量氧疗联合面罩无创机械通气的危重症 SARS-CoV-2 患者中，气管插管的需求较低。
