Šitum Ivan, Hrvoić Lovro, Erceg Ante, Mandarić Anja, Karmelić Dora, Mamić Gloria, Džaja Nikolina, Babić Anđela, Mihaljević Slobodan, Mažar Mirabel, Lovrić Daniel
Department of Anesthesiology, Reanimatology, Intensive Medicine and Pain Therapy University Hospital Centre Zagreb.
Department of Emergency Medicine University Hospital Centre Zagreb.
Can J Respir Ther. 2024 Oct 31;60:164-172. doi: 10.29390/001c.125145. eCollection 2024.
Previous studies exploring the application of noninvasive ventilation or high-flow nasal cannula in patients with COVID-19-related acute respiratory distress syndrome (ARDS) have yielded conflicting results on whether any method of respiratory support is superior. Our aim is to compare the efficacy and safety of respiratory therapy with high-flow nasal cannula and noninvasive ventilation with continuous positive airway pressure in treatment of COVID-19-related ARDS.
This is a retrospective cohort study based on data from patients who received respiratory support as part of their treatment in the COVID intensive care unit at the University Hospital Centre Zagreb between February 2021 and February 2023. Using propensity score analysis, 42 patients treated with high-flow nasal cannula (HFNC group) were compared to 42 patients treated with noninvasive ventilation with continuous positive airway pressure (CPAP group). Primary outcome was intubation rate.
Intubation rate was 71.4% (30/42) in the HFNC group and 40.5% (17/42) in the CPAP group ( = 0.004). Hazard ratio for intubation was 3.676 (95% confidence interval [CI] 1.480 to 9.232) with the HFNC versus CPAP group. Marginally significant difference in survival between the two groups was observed at 30 days ( = 0.050) but was statistically significant at 60 days ( = 0.043).
Respiratory support with high-flow nasal cannula and noninvasive ventilation with continuous positive airway pressure yielded significantly different intubation rates in favour of continuous positive airway pressure. The same patients also had better 30-day and 60-day survival post-admission.
先前关于在新型冠状病毒肺炎相关急性呼吸窘迫综合征（ARDS）患者中应用无创通气或高流量鼻导管的研究，在何种呼吸支持方法更具优势这一问题上得出了相互矛盾的结果。我们的目的是比较高流量鼻导管呼吸治疗与持续气道正压无创通气在治疗新型冠状病毒肺炎相关ARDS中的疗效和安全性。
这是一项回顾性队列研究，基于2021年2月至2023年2月在萨格勒布大学医院中心新冠重症监护病房接受呼吸支持治疗的患者数据。采用倾向评分分析，将42例接受高流量鼻导管治疗的患者（高流量鼻导管组）与42例接受持续气道正压无创通气治疗的患者（持续气道正压组）进行比较。主要结局是插管率。
高流量鼻导管组的插管率为71.4%（30/42），持续气道正压组为40.5%（17/42）（P = 0.004）。高流量鼻导管组与持续气道正压组相比，插管的风险比为3.676（95%置信区间[CI] 1.480至9.232）。两组在30天时的生存差异边缘显著（P = 0.050），但在60天时具有统计学意义（P = 0.043）。
高流量鼻导管呼吸支持和持续气道正压无创通气的插管率有显著差异，持续气道正压更具优势。相同患者在入院后30天和60天的生存率也更高。
