Department of Emergency Medicine, Clinical Medical College, Yangzhou University (Northern Jiangsu People's Hospital), Yangzhou, China.
Saudi J Gastroenterol. 2024 Sep 1;30(5):302-309. doi: 10.4103/sjg.sjg_24_24. Epub 2024 May 30.
The use of high-flow nasal cannula (HFNC) oxygen therapy is gaining popularity for the treatment of acute hypoxic respiratory failure. However, limited evidence exists regarding the effectiveness of HFNC for acute respiratory distress syndrome (ARDS) in patients with acute pancreatitis (AP).
This retrospective analysis focused on AP patients with mild-moderate ARDS, who were treated with either HFNC or noninvasive ventilation (NIV) in the emergency medicine department, from January 2020 to December 2022. The primary endpoint was treatment failure, defined as either invasive ventilation or a switch to any other study treatment (NIV for patients in the NFNC group and vice versa).
A total of 146 patients with AP (68 in the HFNC group and 78 in the NIV group) were included in this study. The treatment failure rate in the HFNC group was 17.6% and 19.2% in the NIV group - a risk difference of -1.6% (95% CI, -11.3 to 14.0%; P = 0.806). The most common causes of failure in the HFNC group were aggravation of respiratory distress and hypoxemia. However, in the NIV group, the most common reasons for failure were treatment intolerance and exacerbation of respiratory distress. Treatment intolerance in the HFNC group was significantly lower than that in the NIV group (16.7% vs 60.0%, 95% CI -66.8 to -6.2; P = 0.023). Multivariate logistic regression analysis showed that body mass index (≥28), acute physiology and chronic health evaluation II score (≥15), partial arterial oxygen tension/fraction of inspired oxygen (≤200), and respiratory rate (≥32/min) at 1 hour were independent predictors of HFNC failure.
In AP patients with mild-moderate ARDS, the usage of HFNC did not lead to a higher rate of treatment failure when compared to NIV. HFNC is an ideal choice of respiratory support for patients with NIV intolerance, but clinical application should pay attention to the influencing factors of its treatment failure.
高流量鼻导管（HFNC）氧疗在治疗急性低氧性呼吸衰竭方面越来越受欢迎。然而，关于 HFNC 治疗急性胰腺炎（AP）合并急性呼吸窘迫综合征（ARDS）患者的疗效，证据有限。
本回顾性分析聚焦于在急诊科接受 HFNC 或无创通气（NIV）治疗的轻中度 ARDS 的 AP 患者，时间为 2020 年 1 月至 2022 年 12 月。主要终点是治疗失败，定义为需要有创通气或切换至任何其他研究治疗（HFNC 组患者切换至 NIV，反之亦然）。
共纳入 146 例 AP 患者（HFNC 组 68 例，NIV 组 78 例）。HFNC 组的治疗失败率为 17.6%，NIV 组为 19.2%，风险差为-1.6%（95%CI，-11.3 至 14.0%；P=0.806）。HFNC 组最常见的失败原因是呼吸困难和低氧血症加重，而 NIV 组最常见的失败原因是不耐受治疗和呼吸困难加重。HFNC 组不耐受治疗的发生率明显低于 NIV 组（16.7% vs 60.0%，95%CI-66.8 至-6.2；P=0.023）。多变量逻辑回归分析表明，1 小时时的体质量指数（≥28）、急性生理学与慢性健康状况评分系统Ⅱ（≥15）、部分动脉血氧分压/吸入氧浓度（≤200）和呼吸频率（≥32/min）是 HFNC 失败的独立预测因素。
在 AP 合并轻中度 ARDS 患者中，与 NIV 相比，HFNC 治疗并未导致更高的治疗失败率。HFNC 是不耐受 NIV 治疗患者的理想呼吸支持选择，但临床应用应注意其治疗失败的影响因素。
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