Clinic of Chest Diseases, Immunology and Allergology, Institute of Clinical Medicine, Vilnius University, M.K. Ciurlionio 21, 03101 Vilnius, Lithuania.
Centre of Pulmonology and Allergology, Vilnius University Hospital Santaros Klinikos, Santariskiu St. 2, 08661 Vilnius, Lithuania.
Medicina (Kaunas). 2022 Jun 6;58(6):769. doi: 10.3390/medicina58060769.
Respiratory assistance tactic that is best for COVID-19-associated acute hypoxemic respiratory failure (AHRF) individuals has yet to be determined. Patients with AHRF may benefit from the use of a high-flow nasal cannula (HFNC) and non-invasive ventilation (NIV). The goals of this prospective observational research were to estimate predictive factors for HFNC and NIV failure in COVID-19-related AHRF subjects. The research enlisted the participation of 124 patients. A stepwise treatment approach was used. HFNC and NIV were used on 124 (100%) and 64 (51.6%) patients, respectively. Thirty (24.2%) of 124 patients were intubated and received invasive mechanical ventilation. 85 (68.5%) patients were managed successfully. Patients who required NIV exhibited a higher prevalence of treatment failure (70.3% vs. 51.6%, = 0.019) and had higher mortality (59.4% vs. 31.5%, = 0.001) than patients who received HFNC. Using logistic regression, the respiratory rate oxygenation (ROX) index at 24 h (odds ratio (OR) = 0.74, = 0.018) and the Charlson Comorbidity Index (CCI) (OR = 1.60, = 0.003) were found to be predictors of HFNC efficacy. It was the ROX index at 24 h and the CCI optimum cut-off values for HFNC outcome that were 6.1 (area under the curve (AUC) = 0.73) and 2.5 (AUC = 0.68), respectively. Serum ferritin level (OR = 0.23, = 0.041) and lymphocyte count (OR = 1.03, = 0.01) were confirmed as predictors of NIV failure. Serum ferritin level at a cut-off value of 456.2 ng/mL (AUC = 0.67) and lymphocyte count lower than 0.70 per mm, (AUC = 0.70) were associated with NIV failure with 70.5% sensitivity, 68.7% specificity and sensitivity of 84.1%, specificity of 56.2%, respectively. The ROX index at 24 h, CCI, as well as serum ferritin level, and lymphocyte count can be used as markers for HFNC and NIV failure, respectively, in SARS-CoV-2-induced AHRF patients.
用于治疗 COVID-19 相关急性低氧性呼吸衰竭（AHRF）患者的呼吸支持策略尚未确定。AHRF 患者可能受益于高流量鼻导管（HFNC）和无创通气（NIV）的使用。本前瞻性观察性研究的目的是评估 COVID-19 相关 AHRF 患者中 HFNC 和 NIV 失败的预测因素。该研究招募了 124 名患者。采用逐步治疗方法。HFNC 和 NIV 分别用于 124（100%）和 64 名（51.6%）患者。124 名患者中有 30 名（24.2%）需要插管并接受有创机械通气。85 名（68.5%）患者得到成功管理。需要 NIV 的患者治疗失败的发生率更高（70.3%比 51.6%， = 0.019），死亡率也更高（59.4%比 31.5%， = 0.001），高于接受 HFNC 的患者。使用逻辑回归，发现 24 小时呼吸率氧合指数（ROX）（比值比（OR）= 0.74， = 0.018）和 Charlson 合并症指数（CCI）（OR = 1.60， = 0.003）是 HFNC 疗效的预测因素。HFNC 结果的最佳截断值分别为 24 小时 ROX 指数 6.1（曲线下面积（AUC）= 0.73）和 CCI 2.5（AUC = 0.68）。血清铁蛋白水平（OR = 0.23， = 0.041）和淋巴细胞计数（OR = 1.03， = 0.01）被确认为 NIV 失败的预测因素。铁蛋白水平截断值为 456.2ng/ml（AUC = 0.67）和淋巴细胞计数低于 0.70 个/mm（AUC = 0.70）与 NIV 失败相关，敏感性为 70.5%，特异性为 68.7%，敏感性为 84.1%，特异性为 56.2%。24 小时 ROX 指数、CCI 以及血清铁蛋白水平和淋巴细胞计数可分别作为 SARS-CoV-2 诱导的 AHRF 患者 HFNC 和 NIV 失败的标志物。
