Hernández Gonzalo, Vaquero Concepción, Ortiz Ramon, Colinas Laura, de Pablo Raul, Segovia Lourdes, Rodriguez Maria Luisa, Villasclaras Ana, Muñoz-Moreno Juan Francisco, Suarez-Sipmann Fernando, Canabal Alfonso, Cuena Rafael, Roca Oriol
Toledo University Hospital, Toledo, Spain.
Ramón y Cajal University Hospital, Madrid, Spain.
J Intensive Care. 2022 Sep 11;10(1):43. doi: 10.1186/s40560-022-00635-2.
High-flow nasal cannula (HFNC) was shown to be non-inferior to noninvasive ventilation (NIV) for preventing reintubation in a general population of high-risk patients. However, some subgroups of high-risk patients might benefit more from NIV. We aimed to determine whether the presence of many risk factors or overweight (body mass index (BMI) ≥ 25 kg/m) patients could have different response to any preventive therapy, NIV or HFNC in terms of reduced reintubation rate.
Not pre-specified post hoc analysis of a multicentre, randomized, controlled, non-inferiority trial comparing NFNC and NIV to prevent reintubation in patients at risk for reintubation. The original study included patients with at least 1 risk factor for reintubation.
Among 604 included in the original study, 148 had a BMI ≥ 25 kg/m. When adjusting for potential covariates, patients with ≥ 4 risk factors (208 patients) presented a higher risk for reintubation (OR 3.4 [95%CI 2.16-5.35]). Patients with ≥ 4 risk factors presented lower reintubation rates when treated with preventive NIV (23.9% vs 45.7%; P = 0.001). The multivariate analysis of overweight patients, adjusted for covariates, did not present a higher risk for reintubation (OR 1.37 [95%CI 0.82-2.29]). However, those overweight patients presented an increased risk for reintubation when treated with preventive HFNC (OR 2.47 [95%CI 1.18-5.15]).
Patients with ≥ 4 risk factors for reintubation may benefit more from preventive NIV. Based on this result, HFNC may not be the optimal preventive therapy in overweight patients. Specific trials are needed to confirm these results.
对于预防高危患者再插管，高流量鼻导管吸氧（HFNC）已被证明不劣于无创通气（NIV）。然而，一些高危患者亚组可能从NIV中获益更多。我们旨在确定存在多种危险因素或超重（体重指数（BMI）≥25kg/m²）的患者对任何预防性治疗（NIV或HFNC）在降低再插管率方面是否有不同反应。
对一项多中心、随机、对照、非劣效性试验进行未预先指定的事后分析，该试验比较NFNC和NIV预防有再插管风险患者的再插管情况。原始研究纳入了至少有1个再插管危险因素的患者。
在原始研究纳入的604例患者中，148例BMI≥25kg/m²。在调整潜在协变量后，有≥4个危险因素的患者（208例）再插管风险更高（比值比3.4[95%置信区间2.16 - 5.35]）。接受预防性NIV治疗时，有≥4个危险因素的患者再插管率较低（23.9%对45.7%；P = 0.001）。对超重患者进行调整协变量后的多因素分析显示再插管风险没有更高（比值比1.37[95%置信区间0.82 - 2.29]）。然而，这些超重患者接受预防性HFNC治疗时再插管风险增加（比值比2.47[95%置信区间1.18 - 5.15]）。
有≥4个再插管危险因素的患者可能从预防性NIV中获益更多。基于此结果，HFNC可能不是超重患者的最佳预防性治疗方法。需要进行特定试验来证实这些结果。
