Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing 100191, China.
Can Respir J. 2023 Apr 15;2023:6377441. doi: 10.1155/2023/6377441. eCollection 2023.
Limited data are available about the clinical outcomes of AECOPD patients with respiratory acidosis treated with HFNC versus NIV.
We conducted a retrospective study to compare the efficacy of HFNC with NIV as initial ventilation support strategy in AECOPD patients with respiratory acidosis. Propensity score matching (PSM) was implemented to increase between-group comparability. Kaplan-Meier analysis was utilized to evaluate differences between the HFNC success, HFNC failure, and NIV groups. Univariate analysis was performed to identify the features that differed significantly between the HFNC success and HFNC failure groups.
After screening 2219 hospitalization records, 44 patients from the HFNC group and 44 from the NIV group were successfully matched after PSM. The 30-day mortality (4.5% versus 6.8%, = 0.645) and 90-day mortality (4.5% versus 11.4%, = 0.237) did not differ between the HFNC and NIV groups. Length of ICU stay (median: 11 versus 18 days, = 0.001), length of hospital stay (median: 14 versus 20 days, = 0.001), and hospital cost (median: 4392 versus 8403 $USD, = 0.001) were significantly lower in the HFNC group compared with NIV group. The treatment failure rate was much higher in the HFNC group than in the NIV group (38.6% versus 11.4%, = 0.003). However, patients who experienced HFNC failure and switched to NIV showed similar clinical outcomes to those who first received NIV. Univariate analysis showed that log NT-proBNP was an important factor for HFNC failure ( = 0.007).
Compared with NIV, HFNC followed by NIV as rescue therapy may be a viable initial ventilation support strategy for AECOPD patients with respiratory acidosis. NT-proBNP may be an important factor for HFNC failure in these patients. Further well-designed randomized controlled trials are needed for more accurate and reliable results.
关于呼吸性酸中毒的 AECOPD 患者使用 HFNC 与 NIV 治疗的临床结局，目前仅有有限的数据。
我们进行了一项回顾性研究，比较 HFNC 与 NIV 作为初始通气支持策略在呼吸性酸中毒的 AECOPD 患者中的疗效。实施倾向评分匹配（PSM）以增加组间可比性。使用 Kaplan-Meier 分析评估 HFNC 成功组、HFNC 失败组和 NIV 组之间的差异。进行单变量分析以确定 HFNC 成功组和 HFNC 失败组之间存在显著差异的特征。
在筛选了 2219 份住院记录后，HFNC 组和 NIV 组各有 44 例患者在 PSM 后成功匹配。HFNC 组和 NIV 组的 30 天死亡率（4.5%比 6.8%， = 0.645）和 90 天死亡率（4.5%比 11.4%， = 0.237）无差异。HFNC 组的 ICU 住院时间（中位数：11 天比 18 天， = 0.001）、住院时间（中位数：14 天比 20 天， = 0.001）和住院费用（中位数：4392 美元比 8403 美元， = 0.001）均显著低于 NIV 组。HFNC 组的治疗失败率明显高于 NIV 组（38.6%比 11.4%， = 0.003）。然而，HFNC 治疗失败并转为 NIV 的患者与首次接受 NIV 的患者具有相似的临床结局。单变量分析显示，log NT-proBNP 是 HFNC 失败的重要因素（ = 0.007）。
与 NIV 相比，HFNC 随后使用 NIV 作为挽救治疗可能是呼吸性酸中毒的 AECOPD 患者可行的初始通气支持策略。NT-proBNP 可能是这些患者 HFNC 失败的重要因素。需要进行更多设计良好的随机对照试验以获得更准确和可靠的结果。
