Viner Smith Elizabeth, Summers Matthew J, Asser Imogen, Louis Rhea, Lange Kylie, Ridley Emma J, Chapple Lee-Anne S
Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia; Intensive Care Research Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia; Intensive Care Research Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
Aust Crit Care. 2025 Jan;38(1):101097. doi: 10.1016/j.aucc.2024.07.078. Epub 2024 Aug 22.
Use of high-flow nasal cannula (HFNC) and non-invasive ventilation (NIV) in the intensive care unit (ICU) is increasing, yet reporting of nutrition intake, muscle thickness, or recovery outcomes in this population is limited.
The objective of this study was to quantify muscle thickness, nutrition intake, and functional recovery outcomes for patients receiving HFNC/NIV within the ICU.
A single-centre, prospective, observational study in adult ICU patients recruited within 48 hrs of commencing HFNC/NIV. Change in quadriceps muscle layer thickness using ultrasound (primary outcome) and 24 hr nutrition intake from study inclusion to day 7 (D7), functional capacity (Barthel Index), and quality of life (EuroQol five-dimension five-level utility index) at D90 were assessed. Data are n (%), mean ± standard deviation or median [interquartile range], are compared using paired sample t-test, and a P value of <0.05 was considered significant.
Primary outcome data were available for n = 28/42: 64 ± 13 y, 61% male, body mass index: 29.1 ± 9.0 kg/m, and Acute Physiology and Chronic Health Evaluation II score: 17 ± 5. Quadriceps muscle layer thickness reduced from 2.41 ± 0.87 to 2.12 ± 0.73 cm; mean difference: -0.29 cm (95% confidence interval: -0.44, -0.13). Nutrition intake increased from study inclusion to D7: 1735 ± 1283 to 5448 ± 2858 kJ and 17.4 ± 16.6 to 60.9 ± 36.8g protein. Barthel Index was 87 ± 20 at baseline and 91 ± 15 at D90 (out of 100). Quality of life was impaired at D90: 0.64 ± 0.23 (health = 1.0).
Critically ill patients receiving HFNC/NIV experienced muscle loss and impaired quality of life.
重症监护病房（ICU）中高流量鼻导管（HFNC）和无创通气（NIV）的使用正在增加，但该人群营养摄入、肌肉厚度或恢复结局的报告有限。
本研究的目的是量化ICU内接受HFNC/NIV治疗患者的肌肉厚度、营养摄入和功能恢复结局。
对在开始HFNC/NIV治疗后48小时内招募的成年ICU患者进行单中心、前瞻性观察性研究。使用超声评估股四头肌层厚度的变化（主要结局）以及从纳入研究到第7天（D7）的24小时营养摄入量、第90天的功能能力（Barthel指数）和生活质量（欧洲五维五级效用指数）。数据以n（%）、均值±标准差或中位数[四分位间距]表示，采用配对样本t检验进行比较，P值<0.05被认为具有统计学意义。
n = 28/42的患者有主要结局数据：年龄64±13岁，男性占61%，体重指数：29.1±9.0kg/m²，急性生理与慢性健康状况评分II：17±5。股四头肌层厚度从2.41±0.87cm降至2.12±0.73cm；平均差异：-0.29cm（95%置信区间：-0.44，-0.13）。从纳入研究到D7营养摄入量增加：能量从1735±1283kJ增加到5448±2858kJ，蛋白质从17.4±16.6g增加到60.9±36.8g。Barthel指数在基线时为87±20，在D90时为91±15（满分100）。第90天生活质量受损：0.64±0.23（健康状态=1.）。
接受HFNC/NIV治疗的重症患者出现肌肉流失和生活质量受损。
