Intensive and Critical Care Unit, Flinders Medical Centre, Flinders Drive, Bedford Park, SA, Australia.
Intensive and Critical Care Unit, Flinders Medical Centre, Flinders Drive, Bedford Park, SA, Australia; Department of Critical Care Medicine, Flinders University, Bedford Park, SA, Australia.
Aust Crit Care. 2024 May;37(3):455-460. doi: 10.1016/j.aucc.2023.03.005. Epub 2023 May 23.
High-flow nasal cannula (HFNC) oxygen is an alternative to conventional oxygen in acute hypoxaemic respiratory failure. Some patients require intubation, with a risk of delay; thus, early predictors may identify those requiring earlier intubation. The "ROX" index (ratio of pulse oximetry/fraction of inspired oxygen to respiratory rate) predicts intubation in patients with pneumonia treated with HFNC therapy, but this index has not been validated in non-pneumonia causes of acute hypoxaemic respiratory failure.
AIM/OBJECTIVE: The aim of this study was to identify factors associated with intubation in a heterogeneous group of patients with acute hypoxaemic respiratory failure treated with HFNC oxygen.
This prospective observational study was undertaken in an Australian tertiary intensive care unit and included patients over 18 y of age with acute hypoxaemic respiratory failure who were treated with oxygen via HFNC. Vital signs and arterial blood gases were recorded prospectively at baseline and regular prespecified intervals for 48 h after HFNC initiation. Multivariate logistic regression was used to identify the factors associated with intubation.
Forty-three patients were included (N = 43). The multivariate factors associated with intubation were admission Sequential Organ Failure Assessment score (odds ratio [OR]: 1.94 [95% confidence interval {CI}: 1.06-3.57]; p = 0.032) and Pneumonia Severity Index (OR: 0.95 [95% CI: 0.90-0.99]; p = 0.034). The ROX index was not independently associated with intubation when adjusted for Sequential Organ Failure Assessment score (OR: 0.71 [95% CI: 0.47-1.06]; p = 0.09). There was no difference in mortality between patients intubated early (<24 h) compared to those intubated late.
Intubation was associated with admission Sequential Organ Failure Assessment score and Pneumonia Severity Index. The ROX index was not associated with intubation when adjusted for admission Sequential Organ Failure Assessment score. Outcomes were similar irrespective of whether patients were intubated late rather than early.
高流量鼻导管（HFNC）给氧是急性低氧性呼吸衰竭常规氧疗的一种替代方法。部分患者需要插管，存在延误风险；因此，早期预测因子可能会识别出需要更早插管的患者。“ROX”指数（脉搏血氧饱和度/吸入氧分数与呼吸频率之比）可预测接受 HFNC 治疗的肺炎患者的插管，但该指数尚未在非肺炎导致的急性低氧性呼吸衰竭患者中得到验证。
目的/目标：本研究旨在确定接受 HFNC 氧疗的急性低氧性呼吸衰竭患者的异质性人群中与插管相关的因素。
这是一项在澳大利亚三级重症监护病房进行的前瞻性观察性研究，纳入了年龄在 18 岁以上、因急性低氧性呼吸衰竭接受 HFNC 氧疗的患者。在 HFNC 开始后 48 小时内，连续记录生命体征和动脉血气值。采用多变量逻辑回归确定与插管相关的因素。
共纳入 43 例患者（N=43）。与插管相关的多变量因素包括入院序贯器官衰竭评估（SOFA）评分（比值比[OR]：1.94[95%置信区间{CI}：1.06-3.57]；p=0.032）和肺炎严重指数（PSI）（OR：0.95[95% CI：0.90-0.99]；p=0.034）。当调整 SOFA 评分后，ROX 指数与插管无独立相关性（OR：0.71[95% CI：0.47-1.06]；p=0.09）。与早期（<24 小时）插管相比，晚期插管患者的死亡率无差异。
插管与入院 SOFA 评分和 PSI 相关。当调整入院 SOFA 评分后，ROX 指数与插管无相关性。无论患者是晚期还是早期插管，其结局均相似。
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