Failure of high-flow nasal cannula therapy may delay intubation and increase mortality
Failure of high-flow nasal cannula therapy may delay intubation and increase mortality
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DOI：
10.1007/s00134-015-3693-5
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发表时间：
2015-04-01
影响因子：
38.9
通讯作者：
Hong, Sang-Bum
中科院分区：
文献类型：
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作者：
Kang, Byung Ju;Koh, Younsuck;Hong, Sang-Bum
使用高流量鼻插管（HFNC）可避免呼吸衰竭患者插管。然而，目前尚不清楚等到HFNC失败（这会延迟插管）是否有不良影响。本回顾性观察性研究评估了接受HFNC治疗失败患者的ICU总死亡率和其他医院预后。在2013年1月至2014年3月期间，所有在一家三级医院连续接受HFNC治疗但失败并需要插管的患者被纳入研究，并根据开始HFNC后早期（48小时内）或较晚（至少48小时）开始插管进行分类。在175例入组患者中，分别有130例（74.3%）和45例（25.7%）在HFNC治疗前和48 h后插管。两组在大多数基线特征方面相似。早期插管患者的ICU总死亡率（39.2% vs. 66.7%; P = 0.001）优于晚期插管患者。拔管成功率（37.7% vs. 15.6%, P = 0.006）、呼吸机脱机（55.4 vs. 28.9%, P = 0.002）和无呼吸机天数（8.6 +/- A 10.1 vs. 3.6 +/- A 7.5, P = 0.011）也出现了类似的模式。在倾向校正和匹配分析中，早期插管也与更好的ICU总死亡率相关[校正优势比(OR) = 0.317, P = 0.005；OR = 0.369, P = 0.046]。HFNC失败可能导致呼吸衰竭患者延迟插管和更差的临床结果。需要对HFNC失败进行大规模的前瞻性和随机对照研究才能得出明确的结论。
Intubation in patients with respiratory failure can be avoided by high-flow nasal cannula (HFNC) use. However, it is unclear whether waiting until HFNC fails, which would delay intubation, has adverse effects. The present retrospective observational study assessed overall ICU mortality and other hospital outcomes of patients who received HFNC therapy that failed.All consecutive patients in one tertiary hospital who received HFNC therapy that failed and who then required intubation between January 2013 and March 2014 were enrolled and classified according to whether intubation started early (within 48 h) or late (at least 48 h) after commencing HFNC.Of the 175 enrolled patients, 130 (74.3 %) and 45 (25.7 %) were intubated before and after 48 h of HFNC, respectively. The groups were similar in terms of most baseline characteristics. The early intubated patients had better overall ICU mortality (39.2 vs. 66.7 %; P = 0.001) than late intubated patients. A similar pattern was seen with extubation success (37.7 vs. 15.6 %; P = 0.006), ventilator weaning (55.4 vs. 28.9 %; P = 0.002), and ventilator-free days (8.6 +/- A 10.1 vs. 3.6 +/- A 7.5; P = 0.011). In propensity-adjusted and -matched analysis, early intubation was also associated with better overall ICU mortality [adjusted odds ratio (OR) = 0.317, P = 0.005; matched OR = 0.369, P = 0.046].Failure of HFNC might cause delayed intubation and worse clinical outcomes in patients with respiratory failure. Large prospective and randomized controlled studies on HFNC failure are needed to draw a definitive conclusion.