Obradović Dušanka, Milovančev Aleksandra, Plećaš Đurić Aleksandra, Sovilj-Gmizić Stanislava, Đurović Vladimir, Šović Jovica, Đurđević Miloš, Tubić Stevan, Bulajić Jelena, Mišić Milena, Jojić Jovana, Pušara Miroslava, Lazić Ivana, Đurković Mladen, Bek Pupovac Renata, Vulić Aleksandra, Jozing Marija
Faculty of Medicine Novi Sad, University of Novi Sad, Novi Sad, Serbia.
Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia.
Front Med (Lausanne). 2023 Oct 2;10:1244650. doi: 10.3389/fmed.2023.1244650. eCollection 2023.
High-Flow Nasal Cannula (HFNC) oxygen therapy emerged as the therapy of choice in COVID-19-related pneumonia and moderate to severe acute hypoxemic respiratory failure (AHRF). HFNC oxygen therapy in COVID-19 has been recommended based its use to treat AHRF of other etiologies, and studies on assessing outcomes in COVID-19 patients are highly needed. This study aimed to examine outcomes in COVID-19 patients with pneumonia and severe AHRF treated with HFNC.
The study included 235 COVID-19 patients with pneumonia treated with HFNC. Data extracted from medical records included demographic characteristics, comorbidities, laboratory parameters, clinical and oxygenation status, clinical complications, as well as the length of hospital stay. Patients were segregated into two groups based on their oxygen therapy needs: HDU group, those who exclusively required HFNC and ICU group, those whose oxygen therapy needed to be escalated at some point of hospital stay. The primary outcome was the need for respiratory support escalation (noninvasive or invasive mechanical ventilation) and the secondary outcome was the in-hospital all-cause mortality.
The primary outcome was met in 113 (48%) of patients. The overall mortality was 70%, significantly higher in the ICU group [102 (90.2%) vs. 62 (50.1%), < 0.001]. The rate of intrahospital infections was significantly higher in the ICU group while there were no significant differences in the length of hospital stay between the groups. The ICU group exhibited significant increases in D-dimer, NLR, and NEWS values, accompanied by a significant decrease in the SaO/FiO ratio. The multivariable COX proportional regression analysis identified malignancy, higher levels of 4C Mortality Score and NEWS2 as significant predictors of mortality.
High-Flow Nasal Cannula oxygen therapy is a safe type of respiratory support in patients with COVID-19 pneumonia and acute hypoxemic respiratory failure with significantly less possibility for emergence of intrahospital infections. In 52% of patients, HFNC was successful in treating AHRF in COVID-19 patients. Overall, mortality in COVID-19 pneumonia with AHRF is still very high, especially in patients treated with noninvasive/invasive mechanical ventilation.
高流量鼻导管（HFNC）氧疗已成为新型冠状病毒肺炎（COVID-19）相关肺炎及中重度急性低氧性呼吸衰竭（AHRF）的首选治疗方法。基于其在治疗其他病因的AHRF中的应用，HFNC氧疗已被推荐用于COVID-19的治疗，因此迫切需要开展评估COVID-19患者治疗效果的研究。本研究旨在探讨接受HFNC治疗的COVID-19肺炎合并严重AHRF患者的治疗效果。
本研究纳入了235例接受HFNC治疗的COVID-19肺炎患者。从病历中提取的数据包括人口统计学特征、合并症、实验室参数、临床及氧合状态、临床并发症以及住院时间。根据患者的氧疗需求将其分为两组：HDU组，即仅需HFNC的患者；ICU组，即在住院期间某些时刻需要升级氧疗的患者。主要结局是是否需要升级呼吸支持（无创或有创机械通气），次要结局是院内全因死亡率。
113例（48%）患者达到主要结局。总体死亡率为70%，ICU组显著更高[102例（90.2%）对62例（50.1%），P＜0.001]。ICU组医院内感染率显著更高，而两组间住院时间无显著差异。ICU组D-二聚体、中性粒细胞与淋巴细胞比值（NLR）及改良早期预警评分（NEWS）值显著升高，同时动脉血氧分压与吸入氧浓度比值（SaO/FiO）显著降低。多变量COX比例回归分析确定恶性肿瘤、较高的4C死亡评分及NEWS2水平是死亡率的显著预测因素。
高流量鼻导管氧疗对于COVID-19肺炎合并急性低氧性呼吸衰竭患者是一种安全的呼吸支持方式，医院内感染发生率显著更低。在52%的患者中，HFNC成功治疗了COVID-19患者的AHRF。总体而言，COVID-19肺炎合并AHRF患者的死亡率仍然很高，尤其是接受无创/有创机械通气治疗的患者。
