经鼻高流量湿化氧疗与无创通气对肥胖患者拔管后拔管成功的影响：对 MIMIC-IV 数据库的回顾性分析。
Effect of high-flow nasal cannula versus non-invasive ventilation after extubation on successful extubation in obese patients: a retrospective analysis of the MIMIC-IV database.
机构信息
Department of Critical Care Medicine, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, Henan, China.
Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, Henan, China.
出版信息
BMJ Open Respir Res. 2023 Aug;10(1). doi: 10.1136/bmjresp-2023-001737.
BACKGROUND
The pathophysiological characteristics of the respiratory system of obese patients differ from those of non-obese patients. Few studies have evaluated the effects of high-flow nasal cannula (HFNC) and non-invasive ventilation (NIV) on the prognosis of obese patients. We here compared the effects of these two techniques on the prevention of reintubation after extubation for obese patients.
METHODS
Data were extracted from the Medical Information Mart for Intensive Care database. Patients who underwent HFNC or NIV treatment after extubation were assigned to the HFNC or NIV group, respectively. The reintubation risk within 96 hours postextubation was compared between the two groups using a doubly robust estimation method. Propensity score matching was performed for both groups.
RESULTS
This study included 757 patients (HFNC group: n=282; NIV group: n=475). There was no significant difference in the risk of reintubation within 96 hours after extubation for the HFNC group compared with the NIV group (OR 1.50, p=0.127). Among patients with body mass index ≥40 kg/m, the HFNC group had a significantly lower risk of reintubation within 96 hours after extubation (OR 0.06, p=0.016). No significant differences were found in reintubation rates within 48 hours (15.6% vs 11.0%, p=0.314) and 72 hours (16.9% vs 13.0%, p=0.424), as well as in hospital mortality (3.2% vs 5.2%, p=0.571) and intensive care unit (ICU) mortality (1.3% vs 5.2%, p=0.108) between the two groups. However, the HFNC group had significantly longer hospital stays (14 days vs 9 days, p=0.005) and ICU (7 days vs 5 days, p=0.001) stays.
CONCLUSIONS
This study suggests that HFNC therapy is not inferior to NIV in preventing reintubation in obese patients and appears to be advantageous in severely obese patients. However, HFNC is associated with significantly longer hospital stays and ICU stays.
背景
肥胖患者呼吸系统的病理生理特征与非肥胖患者不同。很少有研究评估高流量鼻导管（HFNC）和无创通气（NIV）对肥胖患者预后的影响。我们在此比较了这两种技术对预防肥胖患者拔管后再插管的效果。
方法
从医疗信息集市重症监护数据库中提取数据。拔管后接受 HFNC 或 NIV 治疗的患者分别被分配到 HFNC 或 NIV 组。使用双重稳健估计方法比较两组患者拔管后 96 小时内再插管的风险。对两组进行倾向评分匹配。
结果
本研究纳入了 757 名患者（HFNC 组：n=282；NIV 组：n=475）。HFNC 组与 NIV 组相比，拔管后 96 小时内再插管的风险无显著差异（OR 1.50，p=0.127）。在 BMI≥40kg/m2的患者中，HFNC 组拔管后 96 小时内再插管的风险显著降低（OR 0.06，p=0.016）。两组在 48 小时（15.6% vs 11.0%，p=0.314）和 72 小时（16.9% vs 13.0%，p=0.424）内的再插管率以及院内死亡率（3.2% vs 5.2%，p=0.571）和 ICU 死亡率（1.3% vs 5.2%，p=0.108）均无显著差异。然而，HFNC 组的住院时间（14 天 vs 9 天，p=0.005）和 ICU 住院时间（7 天 vs 5 天，p=0.001）明显更长。
结论
本研究表明，HFNC 治疗在预防肥胖患者再插管方面并不逊于 NIV，并且在严重肥胖患者中似乎具有优势。然而，HFNC 与明显更长的住院时间和 ICU 住院时间有关。
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