Abstract：
OBJECTIVE: To determine the relative effectiveness of Helmet-CPAP (H_CPAP) with respect to high-flow nasal cannula oxygen therapy (HFNO) in avoiding greater need for intubation or mortality in a medium complexity hospital in Chile during the year 2021.
METHODS: Cohort analytical study, single center.
METHODS: Units other than intensive care units.
METHODS: Records of adults with mild to moderate hypoxemia due to coronavirus type 2.
METHODS: None.
METHODS: Need for intubation or mortality.
RESULTS: 159 patients were included in the study, with a ratio by support of 2:10 (H_CPAP:HFNO). The 46.5% were women, with no significant differences by sex according to support (p = 0.99, Fisher test). The APACHE II score, for HFNO, had a median of 10.5, 3.5 units higher than H_CPAP (p < 0.01, Wilcoxon rank sum). The risk of intubation in HFNO was 42.1% and in H_CPAP 3.8%, with a significant risk reduction of 91% (95% CI: 36.9%-98.7%; p < 0.01). APACHE II does not modify or confound the support and intubation relationship (p > 0.2, binomial regression); however, it does confound the support and mortality relationship (p = 0.82, RR homogeneity test). Despite a 79.1% reduction in mortality risk with H_CPAP, this reduction was not statistically significant (p = 0.11, binomial regression).
CONCLUSIONS: The use of Helmet CPAP, when compared to HFNO, was an effective therapeutic ventilatory support strategy to reduce the risk of intubation in patients with mild to moderate hypoxemia caused by coronavirus type 2 in inpatient units other than intensive care. The limitations associated with the difference in size, age and severity between the arms could generate bias.
METHODS: Cohort analytical study, single center.
METHODS: Units other than intensive care units.
METHODS: Records of adults with mild to moderate hypoxemia due to coronavirus type 2.
METHODS: None.
METHODS: Need for intubation or mortality.
RESULTS: 159 patients were included in the study, with a ratio by support of 2:10 (H_CPAP:HFNO). The 46.5% were women, with no significant differences by sex according to support (p = 0.99, Fisher test). The APACHE II score, for HFNO, had a median of 10.5, 3.5 units higher than H_CPAP (p < 0.01, Wilcoxon rank sum). The risk of intubation in HFNO was 42.1% and in H_CPAP 3.8%, with a significant risk reduction of 91% (95% CI: 36.9%-98.7%; p < 0.01). APACHE II does not modify or confound the support and intubation relationship (p > 0.2, binomial regression); however, it does confound the support and mortality relationship (p = 0.82, RR homogeneity test). Despite a 79.1% reduction in mortality risk with H_CPAP, this reduction was not statistically significant (p = 0.11, binomial regression).
CONCLUSIONS: The use of Helmet CPAP, when compared to HFNO, was an effective therapeutic ventilatory support strategy to reduce the risk of intubation in patients with mild to moderate hypoxemia caused by coronavirus type 2 in inpatient units other than intensive care. The limitations associated with the difference in size, age and severity between the arms could generate bias.
摘要：
目的：确定Helmet-CPAP（H_CPAP）在高流量鼻插管氧疗（HFNO）方面的相对有效性，以避免在智利一家中等复杂性医院中更大的插管需求或死亡率。2021年。
方法：队列分析研究，单中心。
方法：重症监护病房以外的病房。
方法：2型冠状病毒引起的轻度至中度低氧血症的成人记录。
方法：无。
方法：需要插管或死亡。
结果：159名患者被纳入研究，支持比例为2:10(H_CPAP:HFNO)。46.5%是女性，根据支持度，性别无显著差异(p=0.99，Fisher检验)。APACHEII得分,对于HFNO，中位数为10.5，比H_CPAP高3.5个单位(p<0.01，Wilcoxon秩和)。HFNO插管风险为42.1%,H_CPAP插管风险为3.8%,风险显着降低91%（95%CI：36.9%-98.7%；p<0.01）。APACHEII不会修改或混淆支持和插管关系（p>0.2，二项回归）；但是，它确实混淆了支持和死亡率的关系(p=0.82,RR同质性检验).尽管H_CPAP的死亡风险降低了79.1%，这一降低没有统计学意义(p=0.11,二项回归).
结论：头盔CPAP的使用，与HFNO相比，是一种有效的治疗性通气支持策略，可降低重症监护以外的住院病房中由2型冠状病毒引起的轻度至中度低氧血症患者的插管风险。与尺寸差异相关的限制，两臂之间的年龄和严重程度可能会产生偏见。
方法：队列分析研究，单中心。
方法：重症监护病房以外的病房。
方法：2型冠状病毒引起的轻度至中度低氧血症的成人记录。
方法：无。
方法：需要插管或死亡。
结果：159名患者被纳入研究，支持比例为2:10(H_CPAP:HFNO)。46.5%是女性，根据支持度，性别无显著差异(p=0.99，Fisher检验)。APACHEII得分,对于HFNO，中位数为10.5，比H_CPAP高3.5个单位(p<0.01，Wilcoxon秩和)。HFNO插管风险为42.1%,H_CPAP插管风险为3.8%,风险显着降低91%（95%CI：36.9%-98.7%；p<0.01）。APACHEII不会修改或混淆支持和插管关系（p>0.2，二项回归）；但是，它确实混淆了支持和死亡率的关系(p=0.82,RR同质性检验).尽管H_CPAP的死亡风险降低了79.1%，这一降低没有统计学意义(p=0.11,二项回归).
结论：头盔CPAP的使用，与HFNO相比，是一种有效的治疗性通气支持策略，可降低重症监护以外的住院病房中由2型冠状病毒引起的轻度至中度低氧血症患者的插管风险。与尺寸差异相关的限制，两臂之间的年龄和严重程度可能会产生偏见。
