Infectious Diseases Division, Complexo Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Brazil.
Rehabilitation in Physical Therapy Unit, Complexo Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Brazil.
Respir Care. 2022 Nov;67(11):1443-1451. doi: 10.4187/respcare.09764. Epub 2022 Aug 9.
COVID-19 pneumonia has been responsible for many ICU patients' admissions with hypoxemic respiratory failure, and oxygen therapy is one of the pillars of its treatment. The current pandemic scenario has limited the availability of ICU beds and access to invasive ventilation equipment. High-flow nasal cannula (HFNC) can reduce the need for orotracheal intubation compared with conventional oxygen therapy, providing better results than noninvasive respiratory support. However, HFNC use has been controversial due to concerns about the benefits and risks of aerosol dispersion. In this context, we evaluated the performance of the HFNC therapy in patients with COVID-19 and investigated factors that can predict favorable responses.
A prospective observational study was conducted, which included hospitalized adult subjects with COVID-19 in the respiratory wards who needed oxygen therapy. Clinical and laboratory parameters were collected to compare HFNC therapy use and the outcomes.
In 6 months, 128 subjects were included and the success rate of HFNC therapy was 53%. Logistic regression analysis showed that the Charlson comorbidity score, need for oxygen flow, [Formula: see text] and breathing frequency predicted therapy failure. The mortality rate increased among the non-responders versus the responders (47% vs 3%), 48% of failure occurred in the first 24 h of the HFNC therapy. A ROX (respiratory frequency - oxygenation) index > 4.98 in 6 h and > 4.53 in 24 h predicted success of the HFNC therapy with an area under the curve of 0.7, and a ROX index < 3.47 predicted failure with 88% of specificity. HFNC in the subjects with COVID-19 was associated with reduced mortality and improved oxygenation in the subjects with respiratory distress. Close monitoring of specific parameters defines eligible patients and rapidly identifies those in need of invasive ventilatory support.
COVID-19 肺炎导致许多 ICU 患者因低氧性呼吸衰竭而入院，氧疗是其治疗的基石之一。当前的大流行情况限制了 ICU 床位和获得有创通气设备的机会。与常规氧疗相比，高流量鼻导管（HFNC）可减少气管插管的需求，并提供比无创呼吸支持更好的效果。然而，由于对气溶胶分散的益处和风险的担忧，HFNC 的使用存在争议。在这种情况下，我们评估了 HFNC 治疗在 COVID-19 患者中的表现，并研究了可以预测良好反应的因素。
进行了一项前瞻性观察性研究，该研究纳入了呼吸病房中需要氧疗的 COVID-19 住院成年患者。收集了临床和实验室参数，以比较 HFNC 治疗的使用和结果。
在 6 个月内，共纳入 128 例患者，HFNC 治疗的成功率为 53%。Logistic 回归分析显示，Charlson 合并症评分、氧气流量需求、[Formula: see text]和呼吸频率预测了治疗失败。与应答者相比，无应答者的死亡率增加（47%对 3%），48%的失败发生在 HFNC 治疗的前 24 小时内。6 小时内 ROX（呼吸频率-氧合）指数>4.98 和 24 小时内 ROX 指数>4.53 预测 HFNC 治疗成功，曲线下面积为 0.7，ROX 指数<3.47 预测失败，特异性为 88%。HFNC 治疗 COVID-19 患者与降低死亡率和改善呼吸窘迫患者的氧合有关。密切监测特定参数可确定符合条件的患者，并迅速识别需要有创通气支持的患者。
