Department of Respiratory Medicine, JSS Medical College, JSS Academy of Higher Education and Research, Mysuru 570015, India.
Public Health Research Institute of India, Mysuru 570020, India.
Viruses. 2023 Sep 5;15(9):1879. doi: 10.3390/v15091879.
High-flow nasal cannula (HFNC) and ventilator-delivered non-invasive mechanical ventilation (NIV) were used to treat acute respiratory distress syndrome (ARDS) due to COVID-19 pneumonia, especially in low- and middle-income countries (LMICs), due to lack of ventilators and manpower resources despite the paucity of data regarding their efficacy. This prospective study aimed to analyse the efficacy of HFNC versus NIV in the management of COVID-19 ARDS. A total of 88 RT-PCR-confirmed COVID-19 patients with moderate ARDS were recruited. Linear regression and generalized estimating equations (GEEs) were used for trends in vital parameters over time. A total of 37 patients were on HFNC, and 51 were on NIV. Patients in the HFNC group stayed slightly but not significantly longer in the ICU as compared to their NIV counterparts (HFNC vs. NIV: 8.00 (4.0-12.0) days vs. 7.00 (2.0-12.0) days; = 0.055). Intubation rates, complications, and mortality were similar in both groups. The switch to HFNC from NIV was 5.8%, while 37.8% required a switch to NIV from HFNC. The resolution of respiratory alkalosis was better with NIV. We conclude that in patients with COVID-19 pneumonia with moderate ARDS, the duration of treatment in the ICU, intubation rate, and mortality did not differ significantly with the use of HFNC or NIV for respiratory support.
高流量鼻导管（HFNC）和呼吸机提供的无创机械通气（NIV）用于治疗 COVID-19 肺炎引起的急性呼吸窘迫综合征（ARDS），尤其是在资源匮乏的中低收入国家（LMICs），由于缺乏呼吸机和人力资源，尽管关于其疗效的数据很少。这项前瞻性研究旨在分析 HFNC 与 NIV 在 COVID-19 ARDS 管理中的疗效。共招募了 88 例经 RT-PCR 确诊的 COVID-19 中度 ARDS 患者。线性回归和广义估计方程（GEEs）用于分析生命参数随时间的趋势。共有 37 例患者接受 HFNC 治疗，51 例患者接受 NIV 治疗。与 NIV 组相比，HFNC 组患者在 ICU 中停留的时间略长，但无统计学意义（HFNC 组 vs. NIV 组：8.00（4.0-12.0）天 vs. 7.00（2.0-12.0）天； = 0.055）。两组的插管率、并发症和死亡率相似。从 NIV 转为 HFNC 的比例为 5.8%，而 37.8%需要从 HFNC 转为 NIV。NIV 更有利于呼吸性碱中毒的缓解。我们得出结论，在 COVID-19 肺炎合并中度 ARDS 的患者中，使用 HFNC 或 NIV 进行呼吸支持治疗，ICU 治疗时间、插管率和死亡率无显著差异。
