Division of Critical Care, Jewish General Hospital, McGill University, Pavilion H-364.1, 3755 Chemin de la Cote-Sainte-Catherine, Montreal, QC, H3T 1E2, Canada.
Can J Anaesth. 2022 May;69(5):582-590. doi: 10.1007/s12630-022-02218-z. Epub 2022 Feb 24.
The optimal noninvasive modality for oxygenation support in COVID-19-associated hypoxemic respiratory failure and its association with healthcare worker infection remain uncertain. We report here our experience using high-flow nasal oxygen (HFNO) as the primary support mode for patients with COVID-19 in our institution.
We conducted a single-centre historical cohort study of all COVID-19 patients treated with HFNO for at least two hours in our university-affiliated and intensivist-staffed intensive care unit (Jewish General Hospital, Montreal, QC, Canada) between 27 August 2020 and 30 April 2021. We report their clinical characteristics and outcomes. Healthcare workers in our unit cared for these patients in single negative pressure rooms wearing KN95 or fit-tested N95 masks; they underwent mandatory symptomatic screening for COVID-19 infection, as well as a period of asymptomatic screening.
One hundred and forty-two patients were analysed, with a median [interquartile range (IQR)] age of 66 [59-73] yr; 71% were male. Patients had a median [IQR] Sequential Organ Failure Assessment Score of 3 [2-3], median [IQR] oxygen saturation by pulse oximetry/fraction of inspired oxygen ratio of 120 [94-164], and a median [IQR] 4C score (a COVID-19-specific mortality score) of 12 [10-14]. Endotracheal intubation occurred in 48/142 (34%) patients, and overall hospital mortality was 16%. Barotrauma occurred in 21/142 (15%) patients. Among 27 symptomatic and 139 asymptomatic screening tests, there were no cases of HFNO-related COVID-19 transmission to healthcare workers.
Our experience indicates that HFNO is an effective first-line therapy for hypoxemic respiratory failure in COVID-19 patients, and can be safely used without significant discernable infection risk to healthcare workers.
在 COVID-19 相关低氧性呼吸衰竭中，最佳的非侵入性氧合支持方式及其与医护人员感染的关系仍不确定。我们在此报告我们在机构中使用高流量鼻氧（HFNO）作为 COVID-19 患者主要支持模式的经验。
我们对 2020 年 8 月 27 日至 2021 年 4 月 30 日期间在我们大学附属和重症监护人员配备的重症监护室（加拿大蒙特利尔犹太总医院）接受至少两小时 HFNO 治疗的所有 COVID-19 患者进行了一项单中心历史队列研究。我们报告了他们的临床特征和结局。我们单位的医护人员在单间负压室中照顾这些患者，佩戴 KN95 或经过适合测试的 N95 口罩；他们接受了 COVID-19 感染症状筛查以及无症状筛查。
共分析了 142 例患者，中位（四分位距）年龄为 66 [59-73] 岁；71%为男性。患者的中位（四分位距）序贯器官衰竭评估评分 3 [2-3]，中位（四分位距）脉搏血氧饱和度/吸入氧分数 120 [94-164]，中位（四分位距）4C 评分（一种 COVID-19 特异性死亡率评分）12 [10-14]。142 例患者中有 48 例（34%）进行了气管插管，总住院死亡率为 16%。21 例（15%）患者发生气压伤。27 例症状性和 139 例无症状筛查检测中，均未发生 HFNO 相关 COVID-19 传播给医护人员的情况。
我们的经验表明，HFNO 是 COVID-19 患者低氧性呼吸衰竭的有效一线治疗方法，并且可以在没有明显可察觉的感染风险的情况下安全使用，而不会对医护人员造成感染。
