高流量鼻导管给氧与标准氧疗用于新型冠状病毒肺炎所致急性低氧性呼吸衰竭的研究
High-Flow Nasal Cannula and Standard Oxygen in Acute Hypoxemic Respiratory Failure Due to COVID-19.
作者信息
Gallardo Adrián, Dévoli Adrián P, Arévalo Germán Em Bustillo, Saavedra Santiago N, Moracci Roque S, Pratto Romina A, Plotnikow Gustavo A, Leone José L, Travetto Carolina M
机构信息
Department of Kinesiology, Respiratory Care Unit, Sanatorio Clínica Modelo de Morón, Buenos Aires, Argentina.
Department of Internal Medicine, Sanatorio Clínica Modelo de Morón, Buenos Aires, Argentina.
出版信息
Respir Care. 2022 Nov 28;67(12):1534-1541. doi: 10.4187/respcare.10019.
BACKGROUND
The evidence regarding benefits of high-flow nasal cannula (HFNC) in patients with COVID-19 is controversial. The aim of this study was to evaluate the impact of HFNC in comparison with standard oxygen therapy on the frequency of endotracheal intubation at 28 d in subjects with acute hypoxemic respiratory failure (AHRF) secondary to SARS-CoV-2 infection.
METHODS
A retrospective, age- and sex-matched-paired, cohort study was conducted in subjects with moderate-to-severe AHRF. Intervention group was treated with HFNC, and control group was treated with standard oxygen therapy. Baseline characteristics and clinical evolution were analyzed. Mantel-Haenszel test was used for categorical variables. Paired samples Wilcoxon test was used for quantitative variables. Multivariate analysis was performed using conditional multiple logistic regression.
RESULTS
Eighty-four subjects were included. The median time from admission to progression of oxygen therapy to F ≥ 0.5 or HFNC was 1 (interquartile range [IQR] 0-3) d. P /F at the time of oxygen therapy progression showed a median of 150.5 (IQR 100.0-170.0) for the entire sample and was lower in HFNC group compared with control group (median 135 [IQR 96-162] vs median 158 [IQR 132-174], respectively, = .02). Endotracheal intubation at 28 d was observed in 54.8% HFNC and 73.8% standard oxygen (unadjusted odds ratio 0.38 [95% CI 0.13-1.07], = .069). In the multivariate analysis, presence of dyspnea at hospital admission, Sequential Organ Failure Assessment score, and P /F at time of progression of oxygen therapy to F ≥ 0.5 was identified as confounding factors for the association between the intervention group and the outcome. Use of HFNC was not an independent predictor of endotracheal intubation frequency after adjusting confounders (odds ratio 0.26 [95% CI 0.04-1.51], = .13).
CONCLUSIONS
In this study, HFNC therapy in subjects with AHRF secondary to COVID-19 was not an independent predictor of endotracheal intubation, compared with standard oxygen therapy, after adjusting for confounders.
背景
关于高流量鼻导管吸氧（HFNC）对新型冠状病毒肺炎（COVID-19）患者的益处的证据存在争议。本研究旨在评估在因严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染继发急性低氧性呼吸衰竭（AHRF）的患者中，与标准氧疗相比，HFNC对28天内气管插管频率的影响。
方法
对中重度AHRF患者进行一项回顾性、年龄和性别匹配的队列研究。干预组采用HFNC治疗，对照组采用标准氧疗。分析基线特征和临床进展情况。分类变量采用Mantel-Haenszel检验。定量变量采用配对样本Wilcoxon检验。使用条件多重逻辑回归进行多变量分析。
结果
纳入84例患者。从入院到氧疗进展至F≥0.5或HFNC的中位时间为1天（四分位间距[IQR]0-3天）。氧疗进展时的P/F值在整个样本中中位数为150.5（IQR 100.0-170.0），HFNC组低于对照组（中位数分别为135[IQR 96-162]和158[IQR 132-174]，P = 0.02）。28天内气管插管率在HFNC组为54.8%，标准氧疗组为73.8%（未调整优势比0.38[95%CI 0.13-1.07]，P = 0.069）。在多变量分析中，入院时存在呼吸困难、序贯器官衰竭评估评分以及氧疗进展至F≥0.5时的P/F值被确定为干预组与结局之间关联的混杂因素。调整混杂因素后，使用HFNC并非气管插管频率的独立预测因素（优势比0.26[95%CI 0.04-1.51]，P = 0.13）。
结论
在本研究中，对于COVID-19继发AHRF的患者，调整混杂因素后，与标准氧疗相比，HFNC治疗并非气管插管的独立预测因素。
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