Fisher Julia M, Subbian Vignesh, Essay Patrick, Pungitore Sarah, Bedrick Edward J, Mosier Jarrod M
Statistics Consulting Laboratory, The University of Arizona, Tucson, AZ.
BIO5 Institute, The University of Arizona, Tucson, AZ.
medRxiv. 2022 Dec 20:2022.12.19.22283704. doi: 10.1101/2022.12.19.22283704.
The goal of this study was to compare noninvasive respiratory support to invasive mechanical ventilation as the initial respiratory support in COVID-19 patients with acute hypoxemic respiratory failure.
All patients admitted to a large healthcare network with acute hypoxemic respiratory failure associated with COVID-19 and requiring respiratory support were eligible for inclusion. We compared patients treated initially with noninvasive respiratory support (noninvasive positive pressure ventilation by facemask or high flow nasal oxygen) with patients treated initially with invasive mechanical ventilation. The primary outcome was time-to-in-hospital death analyzed using an inverse probability of treatment weighted Cox model adjusted for potential confounders. Secondary outcomes included unweighted and weighted assessments of mortality, lengths-of-stay (intensive care unit and hospital) and time-to-intubation.
Over the study period, 2354 patients met inclusion criteria. Nearly half (47%) received invasive mechanical ventilation first and 53% received initial noninvasive respiratory support. There was an overall 38% in-hospital mortality (37% for invasive mechanical ventilation and 39% for noninvasive respiratory support). Initial noninvasive respiratory support was associated with an increased hazard of death compared to initial invasive mechanical ventilation (HR: 1.61, p < 0.0001, 95% CI: 1.33 - 1.94). However, patients on initial noninvasive respiratory support also experienced an increased hazard of leaving the hospital sooner, but the hazard ratio waned with time (HR: 0.97, p < 0.0001, 95% CI: 0.96 - 0.98).
These data show that the COVID-19 patients with acute hypoxemic respiratory failure initially treated with noninvasive respiratory support had an increased hazard of in-hospital death.
本研究的目的是比较无创呼吸支持与有创机械通气作为新型冠状病毒肺炎（COVID-19）急性低氧性呼吸衰竭患者初始呼吸支持的效果。
所有因COVID-19相关急性低氧性呼吸衰竭入住大型医疗网络且需要呼吸支持的患者均符合纳入标准。我们将初始接受无创呼吸支持（面罩无创正压通气或高流量鼻导管吸氧）的患者与初始接受有创机械通气的患者进行了比较。主要结局是使用经潜在混杂因素调整的治疗加权Cox逆概率模型分析的院内死亡时间。次要结局包括死亡率的未加权和加权评估、住院时间（重症监护病房和医院）以及气管插管时间。
在研究期间，2354例患者符合纳入标准。近一半（47%）的患者首先接受了有创机械通气，53%的患者接受了初始无创呼吸支持。总体院内死亡率为38%（有创机械通气组为37%，无创呼吸支持组为39%）。与初始有创机械通气相比，初始无创呼吸支持与死亡风险增加相关（风险比：1.61，p<0.0001，95%置信区间：1.33 - 1.94）。然而，初始接受无创呼吸支持治疗的患者出院时间提前的风险也增加，但风险比随时间下降（风险比：0.97，p<0.0001，95%置信区间：0.96 - 0.98）。
这些数据表明，初始接受无创呼吸支持治疗的COVID-19急性低氧性呼吸衰竭患者院内死亡风险增加。
