呼吸频率和氧合指数对冠状病毒病肺炎高流量鼻导管支持成功的可靠性：一项回顾性队列研究。
Reliability of the respiratory rate and oxygenation index for successful high-flow nasal cannula support in coronavirus disease pneumonia: a retrospective cohort study.
机构信息
Department of Respiratory Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minatojima-Minamimachi, Chuo-Ku, Kobe, Hyogo, 650-0047, Japan.
Department of Infectious Disease, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan.
出版信息
BMC Pulm Med. 2023 Aug 10;23(1):294. doi: 10.1186/s12890-023-02598-y.
BACKGROUND
High-flow nasal cannula (HFNC) therapy is an important non-invasive respiratory support in acute respiratory failure, including coronavirus disease (COVID-19) pneumonia. Although the respiratory rate and oxygenation (ROX) index is a simple and useful predictor for HFNC failure and mortality, there is limited evidence for its use in patients with COVID-19 pneumonia. We aimed to evaluate the ROX index as a predictor for HFNC failure in patients with COVID-19 pneumonia. We also evaluated the ROX index as a predictor for 28-day mortality.
METHODS
In this single-center, retrospective, cohort study, 248 patients older than 18 years of age with COVID-19 pneumonia received HFNC therapy for acute respiratory failure. The ROX index was evaluated within 4 h from the start of HFNC therapy. Past medical history, laboratory data, and the ROX index were evaluated as predictors for HFNC failure and 28-day mortality.
RESULTS
The ROX index < 4.88 showed a significantly high risk ratio for HFNC failure (2.13 [95% confidence interval [CI]: 1.47 - 3.08], p < 0.001). The ROX index < 4.88 was significantly associated with 28-day mortality (p = 0.049) in patients with COVID-19 pneumonia receiving HFNC therapy. Age, chronic hypertension, high lactate dehydrogenase level, and low ROX index showed significantly high risk ratio for HFNC failure. C-reactive protein level and low ROX index were predictors of 28-day morality.
CONCLUSION
The ROX index is a useful predictor for HFNC success and 28-day mortality in patients with COVID-19 pneumonia receiving HFNC therapy.
TRIAL REGISTRATION
An independent ethics committee approved the study (Research Ethics Review Committee of Kobe City Medical Center General Hospital [number: zn220303; date: February 21, 2022]), which was performed in accordance with the Declaration of Helsinki, Guidelines for Good Clinical Practice.
背景
高流量鼻导管（HFNC）治疗是急性呼吸衰竭的重要非侵入性呼吸支持手段，包括冠状病毒病（COVID-19）肺炎。虽然呼吸频率和氧合指数（ROX）是预测 HFNC 治疗失败和死亡率的简单而有用的指标，但在 COVID-19 肺炎患者中应用该指标的证据有限。我们旨在评估 ROX 指数作为预测 COVID-19 肺炎患者 HFNC 治疗失败的指标。我们还评估了 ROX 指数作为预测 28 天死亡率的指标。
方法
在这项单中心、回顾性队列研究中，248 名年龄大于 18 岁的 COVID-19 肺炎患者因急性呼吸衰竭接受 HFNC 治疗。HFNC 治疗开始后 4 小时内评估 ROX 指数。既往病史、实验室数据和 ROX 指数被评估为 HFNC 治疗失败和 28 天死亡率的预测指标。
结果
ROX 指数<4.88 与 HFNC 治疗失败的高风险比显著相关（2.13 [95%置信区间（CI）：1.47-3.08]，p<0.001）。在接受 HFNC 治疗的 COVID-19 肺炎患者中，ROX 指数<4.88 与 28 天死亡率显著相关（p=0.049）。年龄、慢性高血压、高乳酸脱氢酶水平和低 ROX 指数与 HFNC 治疗失败的高风险比显著相关。C 反应蛋白水平和低 ROX 指数是 28 天死亡率的预测指标。
结论
ROX 指数是预测 COVID-19 肺炎患者 HFNC 治疗成功和 28 天死亡率的有用指标。
试验注册
独立伦理委员会批准了这项研究（神户市医疗中心总医院研究伦理审查委员会[编号：zn220303；日期：2022 年 2 月 21 日]），该研究符合《赫尔辛基宣言》和《良好临床实践指南》。
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