High flow nasal oxygen therapy to avoid invasive mechanical ventilation in SARS-CoV-2 pneumonia: a retrospective study.
High flow nasal oxygen therapy to avoid invasive mechanical ventilation in SARS-CoV-2 pneumonia: a retrospective study.
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DOI：
10.1186/s13613-021-00825-5
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发表时间：
2021-02-27
影响因子：
8.1
通讯作者：
Cohen Y
中科院分区：
文献类型：
--
作者：
Bonnet N;Martin O;Boubaya M;Levy V;Ebstein N;Karoubi P;Tandjaoui-Lambiotte Y;Van Der Meersch G;Oziel J;Soulie M;Ghalayini M;Winchenne A;Zahar JR;Ahmed P;Gaudry S;Cohen Y
高流量鼻导管氧疗（HFNO）预防有创机械通气（IMV）在2019年严重冠状病毒病（COVID-19）中的有效性尚未得到充分证实。本研究的目的是比较两种氧合策略（常规氧合和HFNO）在重症COVID 19患者中的IMV风险。这是一项双中心回顾性研究，于2020年3月11日至5月3日在巴黎地区三级医院的两个重症监护室（ICU）进行。我们招募了因COVID-19和急性呼吸衰竭（ARF）住院的连续患者，这些患者在ICU入院时未接受IMV。主要结局是ICU入院后的IMV率。次要结局为第28天和第60天的死亡、ICU住院时间和第28天的无呼吸机天数。HFNO组的数据与标准氧疗（SOT）组的数据进行了比较，采用加权倾向评分。在符合纳入标准的138例患者中，62例（45%）单独接受SOT治疗，76例（55%）接受HFNO治疗。在HFNO组中，39/76例（51%）患者接受了IMV，SOT组中46/62例（74%）患者接受了IMV（OR 0.37 [95% CI，0.18-0.76] p = 0.007）。加权倾向评分后，HFNO仍与较低的IMV率相关（OR 0.31 [95% CI，0.14-0.66] p = 0.002）。在加权倾向评分后，HFNO组和SOT组的ICU住院时间和第28天和第60天的死亡率无显著差异。HNFO组第28天的无呼吸机天数更长（21天vs 10天，p = 0.005）。在HFNO组中，与IMV相关的预测因素为SAPS 2评分（OR 1.13 [95%CI，1.06-1.20] p = 0.0002）和ROX指数> 4.88（OR 0.23 [95%CI，0.008-0.64] p = 0.006）。COVID-19所致ARF的高流量鼻套管给氧与较低的有创机械通气率相关。
The efficacy of high flow nasal canula oxygen therapy (HFNO) to prevent invasive mechanical ventilation (IMV) is not well established in severe coronavirus disease 2019 (COVID-19). The aim of this study was to compare the risk of IMV between two strategies of oxygenation (conventional oxygenation and HFNO) in critically ill COVID 19 patients. This was a bicenter retrospective study which took place in two intensive care units (ICU) of tertiary hospitals in the Paris region from March 11, to May 3, 2020. We enrolled consecutive patients hospitalized for COVID-19 and acute respiratory failure (ARF) who did not receive IMV at ICU admission. The primary outcome was the rate of IMV after ICU admission. Secondary outcomes were death at day 28 and day 60, length of ICU stay and ventilator-free days at day 28. Data from the HFNO group were compared with those from the standard oxygen therapy (SOT) group using weighted propensity score. Among 138 patients who met the inclusion criteria, 62 (45%) were treated with SOT alone, and 76 (55%) with HFNO. In HFNO group, 39/76 (51%) patients received IMV and 46/62 (74%) in SOT group (OR 0.37 [95% CI, 0.18–0.76] p = 0.007). After weighted propensity score, HFNO was still associated with a lower rate of IMV (OR 0.31 [95% CI, 0.14–0.66] p = 0.002). Length of ICU stay and mortality at day 28 and day 60 did not significantly differ between HFNO and SOT groups after weighted propensity score. Ventilator-free days at days 28 was higher in HNFO group (21 days vs 10 days, p = 0.005). In the HFNO group, predictive factors associated with IMV were SAPS2 score (OR 1.13 [95%CI, 1.06–1.20] p = 0.0002) and ROX index > 4.88 (OR 0.23 [95%CI, 0.008–0.64] p = 0.006). High flow nasal canula oxygen for ARF due to COVID-19 is associated with a lower rate of invasive mechanical ventilation.
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DOI：
10.15557/pimr.2020.0003
发表时间：
2020-01-01
影响因子：
3.6
作者：
通讯作者：
--
影响因子：
24.3
作者：
Franco, Cosimo;Facciolongo, Nicola;Nava, Stefano
通讯作者：
Nava, Stefano
影响因子：
38.9
作者：
COVID-ICU Group on behalf of the REVA Network and the COVID-ICU Investigators
通讯作者：
COVID-ICU Group on behalf of the REVA Network and the COVID-ICU Investigators
影响因子：
6.9
作者：
Leung, C. C. H.;Joynt, G. M.;Hui, M.
通讯作者：
Hui, M.
影响因子：
8.1
作者：
Wang, Ke;Zhao, Wei;Duan, Jun
通讯作者：
Duan, Jun