High-Flow Nasal Cannula Oxygenation in Immunocompromised Patients With Acute Hypoxemic Respiratory Failure: A Groupe de Recherche Respiratoire en Reanimation Onco-Hematologique Study.
High-Flow Nasal Cannula Oxygenation in Immunocompromised Patients With Acute Hypoxemic Respiratory Failure: A Groupe de Recherche Respiratoire en Reanimation Onco-Hematologique Study.
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DOI：
10.1097/ccm.0000000000002085
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发表时间：
2017-03-01
影响因子：
8.8
通讯作者：
Azoulay, Elie
中科院分区：
文献类型：
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作者：
Lemiale, Virginie;Resche-Rigon, Matthieu;Azoulay, Elie
目的：在免疫功能低下的急性呼吸衰竭患者中，有创机械通气仍然与高死亡率相关。在这种情况下，选择适当的氧合策略是至关重要的。最近，高流量鼻吸氧在未经选择的急性呼吸衰竭患者中显示出生存益处。目的：评估免疫功能低下的低氧性急性呼吸衰竭患者使用高流量鼻氧机治疗的结果。设计：我们对免疫功能低下的低氧性急性呼吸衰竭患者进行了一项无创机械通气的随机对照试验。设计：在法国和比利时的29家ICU。研究对象：免疫功能低下的低氧性急性呼吸衰竭患者。干预：采用基于倾向性评分的方法评估高流量鼻氧与标准氧对第28天死亡率的影响。基础疾病主要包括恶性肿瘤(n=296；84%)。急性呼吸衰竭的病因多为肺炎(n=157；44.4%)或机会性感染(n=76；21.5%)。180例(51%)患者接受无创呼吸机治疗。142例(40.2%)患者最终需要有创机械通气。第28天死亡率为22.6%(80例死亡)。在整个ICU期间，127名患者(36%)接受了高流量鼻氧，而226名患者接受了标准氧气。每组90例患者(高流量鼻氧或标准氧)根据倾向评分进行匹配，其中接受无创机械通气的患者为91例(51%)。高流量鼻氧与低插管率(危险比，0.42；95%CI，0.11-1.61；p=0.2)和第28天死亡率(危险比，0.80；95%CI，0.45-1.42；p=0.45)均无相关性。结论：在免疫功能低下的低氧性急性呼吸衰竭患者中，与标准氧相比，高流量鼻氧不会降低插管或存活率。然而，这些结果可能是由于统计能力低或与亚组分析相关的未知混杂因素所致。需要一项随机试验。
OBJECTIVE: In immunocompromised patients with acute respiratory failure, invasive mechanical ventilation remains associated with high mortality. Choosing the adequate oxygenation strategy is of the utmost importance in that setting. High-flow nasal oxygen has recently shown survival benefits in unselected patients with acute respiratory failure. The objective was to assess outcomes of immunocompromised patients with hypoxemic acute respiratory failure treated with high-flow nasal oxygen.DESIGN: We performed a post hoc analysis of a randomized controlled trial of noninvasive ventilation in critically ill immunocompromised patients with hypoxemic acute respiratory failure.SETTING: Twenty-nine ICUs in France and Belgium.PATIENTS: Critically ill immunocompromised patients with hypoxemic acute respiratory failure.INTERVENTION: A propensity score-based approach was used to assess the impact of high-flow nasal oxygen compared with standard oxygen on day 28 mortality.MEASUREMENTS AND MAIN RESULTS: Among 374 patients included in the study, 353 met inclusion criteria. Underlying disease included mostly malignancies (n = 296; 84%). Acute respiratory failure etiologies were mostly pneumonia (n = 157; 44.4%) or opportunistic infection (n = 76; 21.5%). Noninvasive ventilation was administered to 180 patients (51%). Invasive mechanical ventilation was ultimately needed in 142 patients (40.2%). Day 28 mortality was 22.6% (80 deaths). Throughout the ICU stay, 127 patients (36%) received high-flow nasal oxygen whereas 226 patients received standard oxygen. Ninety patients in each group (high-flow nasal oxygen or standard oxygen) were matched according to the propensity score, including 91 of 180 (51%) who received noninvasive ventilation. High-flow nasal oxygen was neither associated with a lower intubation rate (hazard ratio, 0.42; 95% CI, 0.11-1.61; p = 0.2) nor day 28 mortality (hazard ratio, 0.80; 95% CI, 0.45-1.42; p = 0.45).CONCLUSIONS: In immunocompromised patients with hypoxemic acute respiratory failure, high-flow nasal oxygen when compared with standard oxygen did not reduce intubation or survival rates. However, these results could be due to low statistical power or unknown confounders associated with the subgroup analysis. A randomized trial is needed.