Delayed intubation associated with in-hospital mortality in patients with COVID-19 respiratory failure who fail heated and humified high flow nasal canula.
Delayed intubation associated with in-hospital mortality in patients with COVID-19 respiratory failure who fail heated and humified high flow nasal canula.
复制标题
与院内死亡率相关的延迟插管在19.19呼吸衰竭的患者中失败并衰减了高流量鼻canula。
DOI：
10.1186/s12871-023-02198-7
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发表时间：
2023-07-12
影响因子：
2.2
通讯作者：
中科院分区：
文献类型：
--
作者：
在SARS-CoV-2/新冠肺炎大流行高峰期，无创正压呼吸(NIPPV)和加温增湿高流量鼻管(HFNC)等先进呼吸支持方式被用作有创机械通气支持的有效替代方案，用于治疗急性呼吸衰竭。与NiPPV不同，HFNC是一种较新的治疗方式，其在治疗严重ARF患者中的作用尚未明确。此外，对HFNC的应答者和非应答者的特征尚未确定。尽管最近的证据表明，许多接受HFNC治疗的ARF患者在不需要插管的情况下存活下来，但那些失败并随后接受插管的患者结局更差。鉴于在ARF患者中长时间使用HFNC可能会加重患者自身造成的肺损伤，我们假设在那些由新冠肺炎肺炎引起的ARF患者中，在插管前延长HFNC超过24小时将与住院死亡率增加相关。这是一项回顾性的多中心观察性队列研究，研究对象为2,720名继发于SARS-CoV-2/新冠肺炎肺炎的ARF患者，这些患者最初是在班纳卫生系统内接受HFNC治疗的，时间从2020年3月1日到2021年7月31日。在从HFNC到IMV的患者亚组中，我们评估了插管前HFNC持续时间对死亡率的影响。1392例(51%)接受HFNC治疗成功，1328例(49%)HFNC治疗失败，需插管(HFNC转IMV)。调整协变量后，插管前HFNC持续时间少于24小时与死亡率显著相关。在未能通过高频NC的新冠肺炎肺炎所致急性肾衰患者中，插管延迟超过24小时与死亡率增加相关。在线版本包含补充材料，可在10.1186/s12871-023-023-7获得。
Advanced respiratory support modalities such as non-invasive positive pressure ventilation (NiPPV) and heated and humidified high flow nasal canula (HFNC) served as useful alternatives to invasive mechanical ventilatory support for acute respiratory failure (ARF) during the peak of the SARS-CoV-2/COVID-19 pandemic. Unlike NiPPV, HFNC is a newer modality and its role in the treatment of patients with severe ARF is not yet clearly defined. Furthermore, the characteristics of responders versus non-responders to HFNC have not been determined. Although recent evidence indicates that many patients with ARF treated with HFNC survive without needing intubation, those who fail and are subsequently intubated have worse outcomes. Given that prolonged use of HFNC in patients with ARF might exacerbate patient self-inflicted lung injury, we hypothesized that among those patients with ARF due to COVID-19 pneumonia, prolonged HFNC beyond 24 h before intubation would be associated with increased in-hospital mortality. This was a retrospective, multicenter, observational cohort study of 2720 patients treated for ARF secondary to SARS-CoV-2/COVID-19 pneumonia and initially managed with HFNC within the Banner Health system during the period from March 1st, 2020, to July 31st, 2021. In the subgroup of patients for went from HFNC to IMV, we assessed the effect of the duration of HFNC prior to intubation on mortality. 1392 (51%) were successfully treated with HFNC alone and 1328 (49%) failed HFNC and were intubated (HFNC to IMV). When adjusted for the covariates, HFNC duration less than 24 h prior to intubation was significantly associated with reduced mortality. Among patients with ARF due to COVID-19 pneumonia who fail HFNC, delay of intubation beyond 24 h is associated with increased mortality The online version contains supplementary material available at 10.1186/s12871-023-02198-7.
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作者：
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