High-flow nasal oxygen in patients with COVID-19-associated acute respiratory failure

被引：116

作者：

Mellado-Artigas, Ricard ^{[1
]}

Ferreyro, Bruno L. ^{[2
,3
,4
]}

Angriman, Federico ^{[4
,5
]}

Hernandez-Sanz, Maria ^{[6
]}

Arruti, Egoitz ^{[7
]}

Torres, Antoni ^{[8
,9
,10
]}

Villar, Jesus ^{[9
,11
,12
]}

Brochard, Laurent ^{[4
,12
]}

Ferrando, Carlos ^{[1
,9
]}

机构：

[1] Inst Invest August Pi & Sunyer, Hosp Clin, Dept Anesthesiol & Crit Care, Villarroel 170, Barcelona 08025, Spain

[2] Sinai Hlth Syst, Dept Med, Toronto, ON, Canada

[3] Univ Hlth Network, Toronto, ON, Canada

[4] Univ Toronto, Interdept Div Crit Care Med, Toronto, ON, Canada

[5] Sunnybrook Hlth Sci Ctr, Dept Crit Care Med, Toronto, ON, Canada

[6] Hosp Cruces, Dept Anesthesiol & Crit Care, Vizcaya, Spain

[7] Ubikare Technol, Vizcaya, Spain

[8] Inst Iinvest August Pi & Sunyer, Hosp Clin, Dept Respirol, Barcelona, Spain

[9] Inst Salud Carlos III, CIBER Enfermedades Resp, Madrid, Spain

[10] Inst Salud Carlos III, CIBERESUCICOVID, Madrid, Spain

[11] Hosp Univ Dr Negrin, Res Unit, Multidisciplinary Organ Dysfunct Evaluat Res Netw, Las Palmas Gran Canaria, Spain

[12] St Michaels Hosp, Li Kan Shing Knowledge Inst, Keenan Res Ctr Biomed Sci, Toronto, ON, Canada

来源：

CRITICAL CARE | 2021年 / 25卷 / 01期

关键词：

COVID-19; Acute hypoxemic respiratory failure; High-flow nasal oxygen; Ventilator-free days;

D O I：

10.1186/s13054-021-03469-w

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

PurposeWhether the use of high-flow nasal oxygen in adult patients with COVID-19 associated acute respiratory failure improves clinically relevant outcomes remains unclear. We thus sought to assess the effect of high-flow nasal oxygen on ventilator-free days, compared to early initiation of invasive mechanical ventilation, on adult patients with COVID-19.MethodsWe conducted a multicentre cohort study using a prospectively collected database of patients with COVID-19 associated acute respiratory failure admitted to 36 Spanish and Andorran intensive care units (ICUs). Main exposure was the use of high-flow nasal oxygen (conservative group), while early invasive mechanical ventilation (within the first day of ICU admission; early intubation group) served as the comparator. The primary outcome was ventilator-free days at 28 days. ICU length of stay and all-cause in-hospital mortality served as secondary outcomes. We used propensity score matching to adjust for measured confounding.ResultsOut of 468 eligible patients, a total of 122 matched patients were included in the present analysis (61 for each group). When compared to early intubation, the use of high-flow nasal oxygen was associated with an increase in ventilator-free days (mean difference: 8.0 days; 95% confidence interval (CI): 4.4 to 11.7 days) and a reduction in ICU length of stay (mean difference: - 8.2 days; 95% CI - 12.7 to - 3.6 days). No difference was observed in all-cause in-hospital mortality between groups (odds ratio: 0.64; 95% CI: 0.25 to 1.64).ConclusionsThe use of high-flow nasal oxygen upon ICU admission in adult patients with COVID-19 related acute hypoxemic respiratory failure may lead to an increase in ventilator-free days and a reduction in ICU length of stay, when compared to early initiation of invasive mechanical ventilation. Future studies should confirm our findings.

引用

页数：10

共 44 条

[1]

Ferreyro B.L., Angriman F., Munshi L., Et al., Association of noninvasive oxygenation strategies with all-cause mortality in adults with acute hypoxemic respiratory failure: a systematic review and meta-analysis, JAMA, 324, 1, pp. 57-67, (2020)

[2]

Rochwerg B., Granton D., Wang D.X., Et al., High flow nasal cannula compared with conventional oxygen therapy for acute hypoxemic respiratory failure: a systematic review and meta-analysis, Intensive Care Med, 45, 5, pp. 563-572, (2019)

[3]

Azoulay E., Pickkers P., Soares M., Et al., Acute hypoxemic respiratory failure in immunocompromised patients: the Efraim multinational prospective cohort study, Intensive Care Med, 43, 12, pp. 1808-1819, (2017)

[4]

Ricard J.D., Roca O., Lemiale V., Et al., Use of nasal high flow oxygen during acute respiratory failure, Intensive Care Med, (2020)

[5]

Brochard L., Slutsky A., Pesenti A., Mechanical ventilation to minimize progression of lung injury in acute respiratory failure, Am J Respir Crit Care Med, 195, 4, pp. 438-442, (2017)

[6]

Bellani G., Laffey J.G., Pham T., Et al., Noninvasive ventilation of patients with acute respiratory distress syndrome: insights from the LUNG SAFE Study, Am J Respir Crit Care Med, 195, 1, pp. 67-77, (2017)

[7]

Kang B.J., Koh Y., Lim C.M., Et al., Failure of high-flow nasal cannula therapy may delay intubation and increase mortality, Intensive Care Med, 41, 4, pp. 623-632, (2015)

[8]

Pistillo N., Farina O., Driving airway and transpulmonary pressure are correlated to VILI determinants during controlled ventilation, Intensive Care Med, 44, 5, pp. 674-675, (2018)

[9]

Spinelli E., Mauri T., Beitler J.R., Pesenti A., Brodie D., Respiratory drive in the acute respiratory distress syndrome: pathophysiology, monitoring, and therapeutic interventions, Intensive Care Med, 46, 4, pp. 606-618, (2020)

[10]

Zhou F., Yu T., Du R., Et al., Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study, Lancet, 395, 10229, pp. 1054-1062, (2020)

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