Department of Emergency Medicine, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou 225001, China.
Department of Emergency Medicine, Northern Jiangsu People's Hospital Affiliated to Yangzhou University, Yangzhou 225001, China.
Am J Emerg Med. 2024 Sep;83:76-81. doi: 10.1016/j.ajem.2024.07.002. Epub 2024 Jul 4.
The use of high-flow nasal cannula (HFNC) oxygen therapy is gaining popularity for the treatment of acute respiratory failure (ARF). However, limited evidence exists regarding the effectiveness of HFNC for hypoxemic ARF in patients with blunt chest trauma (BCT).
This retrospective analysis focused on BCT patients with mild-moderate hypoxemic ARF who were treated with either HFNC or non-invasive ventilation (NIV) in the emergency medicine department from January 2021 to December 2022. The primary endpoint was treatment failure, defined as either invasive ventilation, or a switch to the other study treatment (NIV for patients in the NFNC group, and vice-versa).
A total of 157 patients with BCT (72 in the HFNC group and 85 in the NIV group) were included in this study. The treatment failure rate in the HFNC group was 11.1% and 16.5% in the NIV group - risk difference of 5.36% (95% CI, -5.94-16.10%; P = 0.366). The most common cause of failure in the HFNC group was aggravation of respiratory distress. While in the NIV group, the most common reason for failure was treatment intolerance. Treatment intolerance in the HFNC group was significantly lower than that in the NIV group (1.4% vs 9.4%, 95% CI 0.40-16.18; P = 0.039). Univariate logistic regression analysis showed that chronic respiratory disease, abbreviated injury scale score (chest) (≥3), Acute Physiology and Chronic Health Evaluation II score (≥15), partial arterial oxygen tension /fraction of inspired oxygen (≤200) at 1 h of treatment and respiratory rate (≥32 /min) at 1 h of treatment were risk factors associated with HFNC failure.
In BCT patients with mild-moderate hypoxemic ARF, the usage of HFNC did not lead to higher rate of treatment failure when compared to NIV. HFNC was found to offer better comfort and tolerance than NIV, suggesting it may be a promising new respiratory support therapy for BCT patients with mild-moderate ARF.
高流量鼻导管（HFNC）氧疗在急性呼吸衰竭（ARF）的治疗中越来越受欢迎。然而，关于 HFNC 治疗钝性胸部创伤（BCT）患者低氧性 ARF 的疗效的证据有限。
本回顾性分析聚焦于 2021 年 1 月至 2022 年 12 月期间在急诊医学科接受 HFNC 或无创通气（NIV）治疗的 BCT 合并轻度至中度低氧性 ARF 患者。主要终点是治疗失败，定义为有创通气或转为另一种研究治疗（HFNC 组的患者转为 NIV，反之亦然）。
本研究共纳入 157 例 BCT 患者（HFNC 组 72 例，NIV 组 85 例）。HFNC 组的治疗失败率为 11.1%，NIV 组为 16.5%，风险差异为 5.36%（95%CI，-5.94 至 16.10%；P=0.366）。HFNC 组最常见的失败原因是呼吸困难加重，而 NIV 组最常见的失败原因是不耐受治疗。HFNC 组的不耐受治疗发生率明显低于 NIV 组（1.4%比 9.4%，95%CI 0.40 至 16.18；P=0.039）。单因素逻辑回归分析显示，慢性呼吸系统疾病、损伤严重度评分（胸部）（≥3）、急性生理学与慢性健康状况评分系统 II 评分（≥15）、治疗 1 小时时的动脉血氧分压/吸入氧分数（≤200）和治疗 1 小时时的呼吸频率（≥32 /min）是与 HFNC 失败相关的危险因素。
在 BCT 合并轻度至中度低氧性 ARF 患者中，与 NIV 相比，HFNC 的治疗失败率没有增加。HFNC 比 NIV 提供更好的舒适性和耐受性，这表明它可能是一种有前途的新的呼吸支持治疗方法，用于治疗 BCT 合并轻度至中度 ARF 患者。
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