PDF(Pubmed)
Abstract：
The pathophysiological characteristics of the respiratory system of obese patients differ from those of non-obese patients. Few studies have evaluated the effects of high-flow nasal cannula (HFNC) and non-invasive ventilation (NIV) on the prognosis of obese patients. We here compared the effects of these two techniques on the prevention of reintubation after extubation for obese patients.
Data were extracted from the Medical Information Mart for Intensive Care database. Patients who underwent HFNC or NIV treatment after extubation were assigned to the HFNC or NIV group, respectively. The reintubation risk within 96 hours postextubation was compared between the two groups using a doubly robust estimation method. Propensity score matching was performed for both groups.
This study included 757 patients (HFNC group: n=282; NIV group: n=475). There was no significant difference in the risk of reintubation within 96 hours after extubation for the HFNC group compared with the NIV group (OR 1.50, p=0.127). Among patients with body mass index ≥40 kg/m2, the HFNC group had a significantly lower risk of reintubation within 96 hours after extubation (OR 0.06, p=0.016). No significant differences were found in reintubation rates within 48 hours (15.6% vs 11.0%, p=0.314) and 72 hours (16.9% vs 13.0%, p=0.424), as well as in hospital mortality (3.2% vs 5.2%, p=0.571) and intensive care unit (ICU) mortality (1.3% vs 5.2%, p=0.108) between the two groups. However, the HFNC group had significantly longer hospital stays (14 days vs 9 days, p=0.005) and ICU (7 days vs 5 days, p=0.001) stays.
This study suggests that HFNC therapy is not inferior to NIV in preventing reintubation in obese patients and appears to be advantageous in severely obese patients. However, HFNC is associated with significantly longer hospital stays and ICU stays.
Data were extracted from the Medical Information Mart for Intensive Care database. Patients who underwent HFNC or NIV treatment after extubation were assigned to the HFNC or NIV group, respectively. The reintubation risk within 96 hours postextubation was compared between the two groups using a doubly robust estimation method. Propensity score matching was performed for both groups.
This study included 757 patients (HFNC group: n=282; NIV group: n=475). There was no significant difference in the risk of reintubation within 96 hours after extubation for the HFNC group compared with the NIV group (OR 1.50, p=0.127). Among patients with body mass index ≥40 kg/m2, the HFNC group had a significantly lower risk of reintubation within 96 hours after extubation (OR 0.06, p=0.016). No significant differences were found in reintubation rates within 48 hours (15.6% vs 11.0%, p=0.314) and 72 hours (16.9% vs 13.0%, p=0.424), as well as in hospital mortality (3.2% vs 5.2%, p=0.571) and intensive care unit (ICU) mortality (1.3% vs 5.2%, p=0.108) between the two groups. However, the HFNC group had significantly longer hospital stays (14 days vs 9 days, p=0.005) and ICU (7 days vs 5 days, p=0.001) stays.
This study suggests that HFNC therapy is not inferior to NIV in preventing reintubation in obese patients and appears to be advantageous in severely obese patients. However, HFNC is associated with significantly longer hospital stays and ICU stays.
摘要：
背景：肥胖患者呼吸系统的病理生理特征与非肥胖患者不同。很少有研究评估高流量鼻插管（HFNC）和无创通气（NIV）对肥胖患者预后的影响。我们在这里比较了这两种技术对预防肥胖患者拔管后再插管的效果。
方法：从重症监护医疗信息集市数据库中提取数据。拔管后接受HFNC或NIV治疗的患者被分配到HFNC或NIV组，分别。使用双重稳健估计方法比较两组拔管后96小时内的再插管风险。两组均进行倾向评分匹配。
结果：本研究包括757例患者（HFNC组：n=282；NIV组：n=475）。与NIV组相比，HFNC组拔管后96小时内再插管的风险没有显着差异（OR1.50，p=0.127）。在体重指数≥40kg/m2的患者中，HFNC组在拔管后96小时内再次插管的风险显着降低（OR0.06，p=0.016）。48小时内再插管率无显著差异(15.6%vs11.0%,p=0.314）和72小时（16.9%vs13.0%，p=0.424),以及医院死亡率(3.2%和5.2%，p=0.571)和重症监护病房(ICU)死亡率(1.3%vs5.2%，两组之间p=0.108）。然而,HFNC组的住院时间明显更长（14天vs9天，p=0.005）和ICU（7天vs5天，p=0.001）停留。
结论：这项研究表明，HFNC治疗在预防肥胖患者再插管方面并不逊色于NIV，并且在严重肥胖患者中似乎是有利的。然而,HFNC与显著延长的住院时间和ICU住院时间相关。
方法：从重症监护医疗信息集市数据库中提取数据。拔管后接受HFNC或NIV治疗的患者被分配到HFNC或NIV组，分别。使用双重稳健估计方法比较两组拔管后96小时内的再插管风险。两组均进行倾向评分匹配。
结果：本研究包括757例患者（HFNC组：n=282；NIV组：n=475）。与NIV组相比，HFNC组拔管后96小时内再插管的风险没有显着差异（OR1.50，p=0.127）。在体重指数≥40kg/m2的患者中，HFNC组在拔管后96小时内再次插管的风险显着降低（OR0.06，p=0.016）。48小时内再插管率无显著差异(15.6%vs11.0%,p=0.314）和72小时（16.9%vs13.0%，p=0.424),以及医院死亡率(3.2%和5.2%，p=0.571)和重症监护病房(ICU)死亡率(1.3%vs5.2%，两组之间p=0.108）。然而,HFNC组的住院时间明显更长（14天vs9天，p=0.005）和ICU（7天vs5天，p=0.001）停留。
结论：这项研究表明，HFNC治疗在预防肥胖患者再插管方面并不逊色于NIV，并且在严重肥胖患者中似乎是有利的。然而,HFNC与显著延长的住院时间和ICU住院时间相关。
