From the Departments of Anesthesiology and Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
Department of Medicine, Intensive Care Unit, Marina del Rey Hospital, Division of Pulmonary & Critical Care Medicine, Cedars-Sinai Health System and Medical Center, Los Angeles, California.
Anesth Analg. 2023 Apr 1;136(4):692-698. doi: 10.1213/ANE.0000000000006211. Epub 2022 Nov 4.
The impact of high-flow nasal cannula (HFNC) on outcomes of patients with respiratory failure from coronavirus disease 2019 (COVID-19) is unknown. We sought to assess whether exposure to HFNC before intubation was associated with successful extubation and in-hospital mortality compared to patients receiving intubation only.
This single-center retrospective study examined patients with COVID-19-related respiratory failure from March 2020 to March 2021 who required HFNC, intubation, or both. Data were abstracted from the electronic health record. Use and duration of HFNC and intubation were examined' as well as demographics and clinical characteristics. We assessed the association between HFNC before intubation (versus without) and chance of successful extubation and in-hospital death using Cox proportional hazards models adjusting for age, sex, race/ethnicity, obesity, hypertension, diabetes, prior chronic obstructive pulmonary disease or asthma, HCO 3 , CO 2 , oxygen-saturation-to-inspired-oxygen (S:F) ratio, pulse, respiratory rate, temperature, and length of stay before intervention.
A total of n = 440 patients were identified, of whom 311 (70.7%) received HFNC before intubation, and 129 (29.3%) were intubated without prior use of HFNC. Patients who received HFNC before intubation had a higher chance of in-hospital death (hazard ratio [HR], 2.08; 95% confidence interval [CI], 1.06-4.05). No difference was found in the chance of successful extubation between the 2 groups (0.70, 0.41-1.20).
Among patients with respiratory failure from COVID-19 requiring mechanical ventilation, patients receiving HFNC before intubation had a higher chance of in-hospital death. Decisions on initial respiratory support modality should weigh the risks of intubation with potential increased mortality associated with HFNC.
高流量鼻导管（HFNC）对 2019 年冠状病毒病（COVID-19）所致呼吸衰竭患者结局的影响尚不清楚。我们旨在评估与仅接受插管的患者相比，插管前接受 HFNC 治疗与成功拔管和院内死亡率之间的相关性。
这项单中心回顾性研究纳入了 2020 年 3 月至 2021 年 3 月因 COVID-19 相关呼吸衰竭需要接受 HFNC、插管或两者治疗的患者。从电子病历中提取数据。评估 HFNC 使用和持续时间以及插管前和插管后的人口统计学和临床特征。我们使用 Cox 比例风险模型评估插管前使用 HFNC（与未使用相比）与成功拔管和院内死亡的相关性，调整了年龄、性别、种族/民族、肥胖、高血压、糖尿病、既往慢性阻塞性肺疾病或哮喘、HCO3、CO2、氧饱和度/吸入氧（S:F）比值、脉搏、呼吸频率、体温和干预前的住院时间。
共纳入 440 例患者，其中 311 例（70.7%）在插管前接受了 HFNC 治疗，129 例（29.3%）未使用 HFNC 即接受了插管。在插管前接受 HFNC 治疗的患者院内死亡的风险更高（风险比[HR]，2.08；95%置信区间[CI]，1.06-4.05）。两组患者成功拔管的机会没有差异（0.70，0.41-1.20）。
在因 COVID-19 需要机械通气的呼吸衰竭患者中，在插管前接受 HFNC 治疗的患者院内死亡的风险更高。初始呼吸支持方式的决策应权衡插管的风险，与 HFNC 相关的潜在死亡率增加。
