Emergency Department-initiated High-flow Nasal Cannula for COVID-19 Respiratory Distress.
Emergency Department-initiated High-flow Nasal Cannula for COVID-19 Respiratory Distress.
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DOI：
10.5811/westjem.2021.3.50116
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发表时间：
2021-07-20
期刊：
影响因子：
--
通讯作者：
Spiegel TF
中科院分区：
文献类型：
--
作者：
Jarou ZJ;Beiser DG;Sharp WW;Chacko R;Goode D;Rubin DS;Kurian D;Dalton A;Estime SR;O'Connor M;Patel BK;Kress JP;Spiegel TF
2019冠状病毒病（COVID-19）患者可迅速发展为进行性呼吸衰竭。COVID-19大流行期间的通气策略旨在尽量减少患者死亡率。在这项研究中，我们检查了急诊科（艾德）启动的高流量鼻插管（HFNC）对COVID-19呼吸窘迫患者的可用性与结局之间的相关性，包括气管插管（ETT）率、死亡率和住院时间。我们对艾德就诊的COVID-19呼吸窘迫患者进行了一项回顾性、非同期队列研究，这些患者在艾德或艾德离开后24小时内需要HFNC或ETT。对引入ED-HFNC方案前后的患者进行了比较。HFNC的使用与艾德ETT发生率降低相关（46.4% vs 26.3%，P <0.001），并降低了在艾德离开后24小时内（85.7% vs 32.6%，P <0.001）或在整个住院期间（89.3% vs 48.4%，P <0.001）需要ETT的患者的累积比例。使用HFNC也与出院生存率增加的趋势相关;然而，这并不具有统计学显著性（50.0% vs 68.4%，P = 0.115）。对重症监护室或住院时间没有影响。两个队列的人口统计学、合并症和疾病严重程度相似。为COVID-19呼吸窘迫患者制定ED-HFNC方案与ETT发生率降低相关。早期开始HFNC是避免ETT和改善COVID-19患者预后的一种有希望的策略。
Patients with coronavirus disease 2019 (COVID-19) can develop rapidly progressive respiratory failure. Ventilation strategies during the COVID-19 pandemic seek to minimize patient mortality. In this study we examine associations between the availability of emergency department (ED)-initiated high-flow nasal cannula (HFNC) for patients presenting with COVID-19 respiratory distress and outcomes, including rates of endotracheal intubation (ETT), mortality, and hospital length of stay. We performed a retrospective, non-concurrent cohort study of patients with COVID-19 respiratory distress presenting to the ED who required HFNC or ETT in the ED or within 24 hours following ED departure. Comparisons were made between patients presenting before and after the introduction of an ED-HFNC protocol. Use of HFNC was associated with a reduced rate of ETT in the ED (46.4% vs 26.3%, P <0.001) and decreased the cumulative proportion of patients who required ETT within 24 hours of ED departure (85.7% vs 32.6%, P <0.001) or during their entire hospitalization (89.3% vs 48.4%, P <0.001). Using HFNC was also associated with a trend toward increased survival to hospital discharge; however, this was not statistically significant (50.0% vs 68.4%, P = 0.115). There was no impact on intensive care unit or hospital length of stay. Demographics, comorbidities, and illness severity were similar in both cohorts. The institution of an ED-HFNC protocol for patients with COVID-19 respiratory distress was associated with reductions in the rate of ETT. Early initiation of HFNC is a promising strategy for avoiding ETT and improving outcomes in patients with COVID-19.
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影响因子：
38.9
作者：
Kang, Byung Ju;Koh, Younsuck;Hong, Sang-Bum
通讯作者：
Hong, Sang-Bum
DOI：
10.1164/rccm.201803-0589oc
发表时间：
2019-06-01
影响因子：
24.7
作者：
Roca, Oriol;Caralt, Berta;Ricard, Jean-Damien
通讯作者：
Ricard, Jean-Damien
影响因子：
3
作者：
Elixhauser, A;Steiner, C;Coffey, RN
通讯作者：
Coffey, RN
气溶胶生成程序和将急性呼吸道感染传播给医疗保健工作者的风险：系统评价。
影响因子：
3.7
作者：
Tran K;Cimon K;Severn M;Pessoa-Silva CL;Conly J
通讯作者：
Conly J
DOI：
10.1186/s13054-018-1990-4
发表时间：
2018-03-20
期刊：
Critical care (London, England)
影响因子：
--
作者：
Helviz Y;Einav S
通讯作者：
Einav S