一项预测高流量氧疗对急性低氧性呼吸衰竭疗效的回顾性研究。

A retrospective study to predict failure of high-flow oxygen therapy for acute hypoxic respiratory failure.

作者信息

Xue Mingming, Liao Fengqing, Xu Feixiang, Chen Yumei, Wang Sheng, Zhou Yannan, Ding Hailin, Lu Su, Yao Chenling, Song Zhenju, Shao Mian

机构信息

Department of Emergency Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.

出版信息

Int J Emerg Med. 2025 May 15;18(1):98. doi: 10.1186/s12245-025-00891-7.

DOI:10.1186/s12245-025-00891-7

PMID:40375069

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12079891/

Abstract

OBJECTIVE

This study aimed to analyze the characteristics of patients who fail high-flow nasal cannula(HFNC) therapy for acute hypoxemic respiratory failure(AHRF) and to identify predictors of treatment failure.

METHODS

This single-center, retrospective, observational study analyzed clinical data from 388 patients with AHRF. Patients were divided into two groups: the HFNC success group (HFNC-S, n = 256) and the HFNC failure group (HFNC-F, n = 132). The primary endpoint was the need for escalation of respiratory support to tracheal intubation in the enrolled patients. The demographic data, laboratory tests, blood gas analysis data, CT severity scores, and disease severity scores were analysed to determine the difference between patients who were successful and those who failed HFNC treatment. Univariate and multivariate logistic regression models were used to assess potential predictors of failure of HFNC for patients with acute hypoxaemic respiratory failure.

RESULTS

The mean age of patients enrolled was 67.97 ± 14.40 years. The HFNC-F group had significantly higher PSI(Pneumonia Severity Index) score, CURB(Confusion, Urea, Respiratory Rate, Blood Pressure, and Age)-65 score, CPIS(Clinical Pulmonary Infection Score) score, CT score and SOFA(Sequential Organ Failure Assessment) scores compared to the HFNC-S group. Within 12 h of the initiation of treatment, the HFNC-F group exhibited significantly lower oxygen saturation index (PaO2/FiO2) and significantly higher respiratory rate. Additionally, the HFNC-F group exhibited significantly higher levels of C-reactive protein (CRP), platelet count (PLT), D-dimer, interleukin-10 (IL-10), total bilirubin (TB) and creatinine (CB), but lower albumin levels. Multivariate analysis identified CT score, SOFA score, interleukin-1β (IL-1β), and albumin as independent predictors of HFNC failure.

CONCLUSION

HFNC is effective for treating AHRF. CT score, SOFA score, IL-1β, and albumin are independent predictors of HFNC failure.

摘要

目的

本研究旨在分析急性低氧性呼吸衰竭（AHRF）患者高流量鼻导管（HFNC）治疗失败的特征，并确定治疗失败的预测因素。

方法

这项单中心、回顾性、观察性研究分析了388例AHRF患者的临床数据。患者分为两组：HFNC成功组（HFNC-S，n = 256）和HFNC失败组（HFNC-F，n = 132）。主要终点是纳入患者是否需要升级呼吸支持至气管插管。分析人口统计学数据、实验室检查、血气分析数据、CT严重程度评分和疾病严重程度评分，以确定HFNC治疗成功与失败患者之间的差异。采用单因素和多因素逻辑回归模型评估急性低氧性呼吸衰竭患者HFNC治疗失败的潜在预测因素。

结果

纳入患者的平均年龄为67.97±14.40岁。与HFNC-S组相比，HFNC-F组的肺炎严重程度指数（PSI）评分、CURB-65评分（意识障碍、尿素、呼吸频率、血压和年龄）、临床肺部感染评分（CPIS）、CT评分和序贯器官衰竭评估（SOFA）评分显著更高。在治疗开始后12小时内，HFNC-F组的氧合指数（PaO2/FiO2）显著更低，呼吸频率显著更高。此外，HFNC-F组的C反应蛋白（CRP）、血小板计数（PLT）、D-二聚体、白细胞介素-10（IL-10）、总胆红素（TB）和肌酐（CB）水平显著更高，但白蛋白水平更低。多因素分析确定CT评分、SOFA评分、白细胞介素-1β（IL-1β）和白蛋白是HFNC治疗失败的独立预测因素。