Booker James, Egglestone Rebecca, Lushington Jack, Burova Maria, Hamilton Laura, Hunter Elsie, Morden Clare, Pandya Darshni, Beecham Ryan, MacKay Robert, Gupta Sanjay, Grocott Michael P, Dushianthan Ahilanandan
General Intensive Care Unit, University Hospital Southampton NHS Foundation Trust, Southampton, GBR.
Medicine, University of Southampton, Southampton, GBR.
Cureus. 2022 Dec 9;14(12):e32362. doi: 10.7759/cureus.32362. eCollection 2022 Dec.
Background The role of non-invasive (continuous positive airway pressure (CPAP) or Non-invasive ventilation (NIV)) respiratory support (NIRS) as a primary oxygenation strategy for COVID-19 patients with acute severe hypoxic respiratory failure (AHRF), as opposed to invasive mechanical ventilation (invasive-MV), is uncertain. While NIRS may prevent complications related to invasive MV, prolonged NIRS and delays in intubation may lead to adverse outcomes. This study was conducted to assess the role of NIRS in COVID-19 hypoxemic respiratory failure and to explore the variables associated with NRIS failure. Methods This is a single-center, observational study of two distinct waves of severe COVID-19 patients admitted to the ICU. Patients initially managed with non-invasive respiratory support with laboratory-confirmed SARS-CoV-2 in acute hypoxaemic respiratory failure were included. Demographics, comorbidities, admission laboratory variables, and ICU admission scores were extracted from electronic health records. Univariate and multiple logistic regression was used to identify predictive factors for invasive mechanical ventilation. Kaplan-Meier survival curves were used to summarise survival between the ventilatory and time-to-intubation groups. Results There were 291 patients, of which 232 were managed with NIRS as an initial ventilation strategy. There was a high incidence of failure (48.7%). Admission APACHE II score, SOFA score, HACOR score, ROX index, and PaO2/FiO2 were all predictive of NIRS failure. Daily (days 1-4) HACOR scores and ROX index measurements highly predicted NIRS failure. Late NIRS failure (>24 hours) was independently associated with increased mortality (44%). Conclusion NIRS is effective as first-line therapy for COVID-19 patients with AHRF. However, failure, particularly delayed failure, is associated with significant mortality. Early prediction of NIRS failure may prevent adverse outcomes.
背景 对于新型冠状病毒肺炎（COVID-19）合并急性重度低氧性呼吸衰竭（AHRF）的患者，与有创机械通气（有创-MV）相对，无创（持续气道正压通气（CPAP）或无创通气（NIV））呼吸支持（NIRS）作为主要氧合策略的作用尚不确定。虽然NIRS可能预防与有创-MV相关的并发症，但NIRS使用时间延长和插管延迟可能导致不良后果。本研究旨在评估NIRS在COVID-19低氧性呼吸衰竭中的作用，并探索与NIRS失败相关的变量。方法 这是一项对入住重症监护病房（ICU）的两波不同的重症COVID-19患者进行的单中心观察性研究。纳入最初采用无创呼吸支持治疗且实验室确诊为SARS-CoV-2感染的急性低氧性呼吸衰竭患者。从电子健康记录中提取人口统计学、合并症、入院实验室变量和ICU入院评分。采用单因素和多因素逻辑回归确定有创机械通气的预测因素。采用Kaplan-Meier生存曲线总结通气组和插管时间组之间的生存情况。结果 共有291例患者，其中232例最初采用NIRS作为通气策略。失败发生率较高（48.7%）。入院急性生理学与慢性健康状况评分系统（APACHE）II评分、序贯器官衰竭评估（SOFA）评分哈考尔（HACOR）评分、ROX指数和动脉血氧分压/吸入氧分数值（PaO2/FiO2）均为NIRS失败的预测因素。每日（第1 - 4天）HACOR评分和ROX指数测量对NIRS失败有高度预测性。晚期NIRS失败（＞24小时）与死亡率增加独立相关（44%）。结论 NIRS作为COVID-19合并AHRF患者的一线治疗有效。然而，失败，尤其是延迟失败，与显著的死亡率相关。早期预测NIRS失败可能预防不良后果。
