High-flow nasal cannula for Acute Respiratory Distress Syndrome (ARDS) due to COVID-19.
High-flow nasal cannula for Acute Respiratory Distress Syndrome (ARDS) due to COVID-19.
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DOI：
10.4081/mrm.2020.693
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发表时间：
2020-01-28
影响因子：
2.3
通讯作者：
Alcaraz AJ
中科院分区：
文献类型：
--
作者：
Panadero C;Abad-Fernández A;Rio-Ramirez MT;Acosta Gutierrez CM;Calderon-Alcala M;Lopez-Riolobos C;Matesanz-Lopez C;Garcia-Prieto F;Diaz-Garcia JM;Raboso-Moreno B;Vasquez-Gambasica Z;Andres-Ruzafa P;Garcia-Satue JL;Calero-Pardo S;Sagastizabal B;Bautista D;Campos A;González M;Grande L;Jimenez Fernandez M;Santiago-Ruiz JL;Caravaca Perez P;Alcaraz AJ
高流量鼻插管氧疗（HFNC）已被证明是治疗急性呼吸窘迫综合征（ARDS）患者的有效方法，但其对COVID-19患者的疗效尚不清楚。我们的目标是描述其作为治疗SARS-CoV-2引起的ARDS的疗法的效用。在单个中心进行了一项回顾性观察性研究，评估了HFNC治疗的COVID-19继发ARDS患者。主要结果是第30天的插管率，这定义了治疗的失败。我们还分析了ROX指数在预测插管需求方面的作用。研究期间，我院肺科共收治了196例双侧肺炎患者，其中40例因出现ARDS而采用HFNC治疗。第30天插管率为52.5%，总死亡率为22.5%。启动HFNC后，不需要插管组SpO2/FiO2比（113.4±6.6 vs 93.7±6.7,p=0.020）明显更好，ROX指数（5.0±1.6 vs 4.0±1.0,p=0.018）也明显更好。治疗开始后2 ~ 6小时ROX指数小于4.94与插管风险增加相关（HR 4.03 [95% CI 1.18 - 13.7]; p=0.026）。高流量治疗在ARDS中是一种有用的治疗方法，可以避免插管或作为桥梁治疗，并且没有观察到因延迟插管而导致死亡率增加。启动HFNC后，ROX指数低于4.94预示需要插管。
High-flow nasal cannula oxygen therapy (HFNC) has been shown to be a useful therapy in the treatment of patients with Acute Respiratory Distress Syndrome (ARDS), but its efficacy is still unknown in patients with COVID-19. Our objective is to describe its utility as therapy for the treatment of ARDS caused by SARS-CoV-2. A retrospective, observational study was performed at a single centre, evaluating patients with ARDS secondary to COVID-19 treated with HFNC. The main outcome was the intubation rate at day 30, which defined failure of therapy. We also analysed the role of the ROX index to predict the need for intubation. In the study period, 196 patients with bilateral pneumonia were admitted to our pulmonology unit, 40 of whom were treated with HFNC due to the presence of ARDS. The intubation rate at day 30 was 52.5%, and overall mortality was 22.5%. After initiating HFNC, the SpO2/FiO2 ratio was significantly better in the group that did not require intubation (113.4±6.6 vs 93.7±6.7, p=0.020), as was the ROX index (5.0±1.6 vs 4.0±1.0, p=0.018). A ROX index less than 4.94 measured 2 to 6 h after the start of therapy was associated with increased risk of intubation (HR 4.03 [95% CI 1.18 – 13.7]; p=0.026). High-flow therapy is a useful treatment in ARDS in order to avoid intubation or as a bridge therapy, and no increased mortality was observed secondary to the delay in intubation. After initiating HFNC, a ROX index below 4.94 predicts the need for intubation.
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影响因子：
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作者：
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DOI：
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