Schmidt Felicitas, Nowak Lorenz, Obereisenbuchler Florian, Hetrodt Justin, Heiß-Neumann Marion, Schönlebe Anna, Heinig-Menhard Katharina, Gesierich Wolfgang, Behr Jürgen, Hatz Rudolf, Dinkel Julien, Stoleriu Mircea-Gabriel
Department of Intensive Care Medicine, Asklepios Lung Clinic Munich-Gauting, Gauting, Germany.
Department of Pneumology, Asklepios Lung Clinic Munich-Gauting, Gauting, Germany; member of the German Centre for Lung Research.
Anaesthesiol Intensive Ther. 2022;54(1):12-17. doi: 10.5114/ait.2022.113738.
High-flow nasal cannula (HFNC) therapy is a helpful tool in the treatment of hypoxaemic respiratory failure. However, the clinical parameters predicting the effectiveness of HFNC in coronavirus-19 disease (COVID-19) patients remain unclear.
Sixteen COVID-19 patients undergoing HFNC in the Asklepios Lung Clinic Munich-Gauting, Germany between 16 March and 3 June 2020 were retrospectively included into the study. Seven patients successfully recovered after HFNC (Group 1), while 9 patients required intubation upon HFNC failure (Group 2). Relevant predictors for an effective HFNC therapy were analysed on day 0 and 4 after HFNC initiation via receiver operating characteristics.
The groups did not differ significantly in terms of age, sex, body mass index, and comorbidities. Five patients died in Group 2 upon disease progression and HFNC failure. Group 1 required a lower oxygen supplementation (FiO2 0.46 [0.31-0.54] vs. 0.72 [0.54-0.76], P = 0.022) and displayed a higher PaO2/FiO2 ratio (115 [111-201] vs. 93.3 [67.2-145], P = 0.042) on day 0. In Group 2, fever persisted on day 4 (38.5 [38.0-39.4]°C vs. 36.5 [31.1-37.1]°C, P = 0.010). Serum C-reactive protein (CRP) levels > 108 mg L-1 (day 0) and persistent oxygen saturation < 89% and PaO2/FiO2 ratio < 91 (day 4) were identified as significant predictors for HFNC failure (area under curve 0.929, 0.933, and 0.893).
Elevated oxygen saturation, decreased FiO2 and reduced serum CRP on day 4 significantly predict HFNC effectiveness in COVID-19 patients. Based on these parameters, larger prospective studies are necessary to further investigate the effectiveness of HFNC in the treatment of COVID-19-associated hypoxaemic respiratory failure.
高流量鼻导管（HFNC）治疗是治疗低氧性呼吸衰竭的一种有效手段。然而，预测HFNC对冠状病毒病（COVID-19）患者疗效的临床参数仍不明确。
回顾性纳入2020年3月16日至6月3日期间在德国慕尼黑-高廷阿斯克勒庇俄斯肺病诊所接受HFNC治疗的16例COVID-19患者。7例患者在接受HFNC治疗后成功康复（第1组），而9例患者在HFNC治疗失败后需要插管（第2组）。通过受试者工作特征分析HFNC有效治疗的相关预测因素，分别在HFNC开始后的第0天和第4天进行。
两组在年龄、性别、体重指数和合并症方面无显著差异。第2组中有5例患者因疾病进展和HFNC治疗失败而死亡。第1组在第0天需要较低的氧补充（吸入氧分数[FiO2]为0.46[0.31 - 0.54]，而第2组为0.72[0.54 - 0.76]，P = 0.022），且显示出较高的动脉血氧分压/吸入氧分数（PaO2/FiO2）比值（115[111 - 201]，而第2组为93.3[67.2 - 145]，P = 0.042）。在第2组中，第4天仍有发热（38.5[38.0 - 39.4]°C，而第1组为36.5[31.1 - 37.1]°C，P = 0.010）。血清C反应蛋白（CRP）水平>108 mg/L（第0天）以及持续的血氧饱和度<89%和PaO2/FiO2比值<91（第4天）被确定为HFNC治疗失败的显著预测因素（曲线下面积分别为0.929、0.933和0.893）。
第4天血氧饱和度升高、FiO2降低和血清CRP降低显著预测HFNC对COVID-19患者的疗效。基于这些参数，有必要开展更大规模的前瞻性研究，以进一步探究HFNC治疗COVID-19相关低氧性呼吸衰竭的疗效。
