García-Fernández Juan Javier, Sánchez-Nicolás José Andrés, Galicia-Puyol Sonia, Gil-Rosa Isabel, Guerras-Conesa Juan José, Bernal-Morell Enrique, Cinesi-Gómez César
Health Sciences PhD Program, Catholic University of Murcia UCAM, Campus de los Jerónimos nº135, Guadalupe, 30107 Murcia, Spain.
Emergency Department, Reina Sofía General University Hospital, 30003 Murcia, Spain.
J Clin Med. 2023 Oct 15;12(20):6537. doi: 10.3390/jcm12206537.
The objective of this study is to assess the failure of therapies with HFNO (high-flow nasal oxygen), CPAP, Bilevel, or combined therapy in patients with hypoxemic acute respiratory failure due to SARS-CoV-2 during their hospitalization.
This was a retrospective and observational study of SARS-CoV-2-positive patients who required non-invasive respiratory support (NIRS) at the Reina Sofía General University Hospital of Murcia between March 2020 and May 2021.
Of 7355 patients, 197 (11.8%) were included; 95 of them failed this therapy (48.3%). We found that during hospitalization in the ward, the combined therapy of HFNO and CPAP had an overall lower failure rate and the highest treatment with Bilevel ( = 0.005). In the comparison of failure in therapy without two levels of airway pressure, HFNO, CPAP, and combined therapy of HFNO with CPAP, (35.6% of patients) presented with 24.2% failure, compared to those who had two levels of pressure with Bilevel and combined therapy of HFNO with Bilevel (64.4% of patients), with 75.8% associated failure (OR: 0, 374; CI 95%: 0.203-0.688. = 0.001).
The use of NIRS during conventional hospitalization is safe and effective in patients with respiratory failure secondary to SARS-CoV-2 infection. The therapeutic strategy of Bilevel increases the probability of failure, with the combined therapy strategy of CPAP and HFNO being the most promising option.
本研究的目的是评估高流量鼻导管吸氧（HFNO）、持续气道正压通气（CPAP）、双水平气道正压通气（Bilevel）或联合治疗对因新型冠状病毒肺炎（SARS-CoV-2）导致的低氧性急性呼吸衰竭患者住院期间治疗失败的情况。
这是一项对2020年3月至2021年5月期间在穆尔西亚雷纳索菲亚综合大学医院需要无创呼吸支持（NIRS）的新型冠状病毒肺炎阳性患者进行的回顾性观察研究。
7355例患者中，197例（11.8%）被纳入研究；其中95例（48.3%）治疗失败。我们发现，在病房住院期间，HFNO和CPAP联合治疗的总体失败率较低，而双水平气道正压通气治疗失败率最高（P = 0.005）。在无气道压力双水平的治疗失败比较中，HFNO、CPAP以及HFNO与CPAP联合治疗（占患者的35.6%）的失败率为24.2%，而采用双水平气道正压通气以及HFNO与双水平气道正压通气联合治疗（占患者的64.4%）的相关失败率为75.8%（比值比：0.374；95%置信区间：0.203 - 0.688；P = 0.001）。
在因SARS-CoV-2感染继发呼吸衰竭的患者常规住院期间使用无创呼吸支持是安全有效的。双水平气道正压通气治疗策略会增加失败的可能性，而CPAP和HFNO联合治疗策略是最有前景的选择。
