Abstract：
OBJECTIVE: The use of high-flow nasal cannula (HFNC) oxygen therapy is gaining popularity for the treatment of acute respiratory failure (ARF). However, limited evidence exists regarding the effectiveness of HFNC for hypoxemic ARF in patients with blunt chest trauma (BCT).
METHODS: This retrospective analysis focused on BCT patients with mild-moderate hypoxemic ARF who were treated with either HFNC or non-invasive ventilation (NIV) in the emergency medicine department from January 2021 to December 2022. The primary endpoint was treatment failure, defined as either invasive ventilation, or a switch to the other study treatment (NIV for patients in the NFNC group, and vice-versa).
RESULTS: A total of 157 patients with BCT (72 in the HFNC group and 85 in the NIV group) were included in this study. The treatment failure rate in the HFNC group was 11.1% and 16.5% in the NIV group - risk difference of 5.36% (95% CI, -5.94-16.10%; P = 0.366). The most common cause of failure in the HFNC group was aggravation of respiratory distress. While in the NIV group, the most common reason for failure was treatment intolerance. Treatment intolerance in the HFNC group was significantly lower than that in the NIV group (1.4% vs 9.4%, 95% CI 0.40-16.18; P = 0.039). Univariate logistic regression analysis showed that chronic respiratory disease, abbreviated injury scale score (chest) (≥3), Acute Physiology and Chronic Health Evaluation II score (≥15), partial arterial oxygen tension /fraction of inspired oxygen (≤200) at 1 h of treatment and respiratory rate (≥32 /min) at 1 h of treatment were risk factors associated with HFNC failure.
CONCLUSIONS: In BCT patients with mild-moderate hypoxemic ARF, the usage of HFNC did not lead to higher rate of treatment failure when compared to NIV. HFNC was found to offer better comfort and tolerance than NIV, suggesting it may be a promising new respiratory support therapy for BCT patients with mild-moderate ARF.
METHODS: This retrospective analysis focused on BCT patients with mild-moderate hypoxemic ARF who were treated with either HFNC or non-invasive ventilation (NIV) in the emergency medicine department from January 2021 to December 2022. The primary endpoint was treatment failure, defined as either invasive ventilation, or a switch to the other study treatment (NIV for patients in the NFNC group, and vice-versa).
RESULTS: A total of 157 patients with BCT (72 in the HFNC group and 85 in the NIV group) were included in this study. The treatment failure rate in the HFNC group was 11.1% and 16.5% in the NIV group - risk difference of 5.36% (95% CI, -5.94-16.10%; P = 0.366). The most common cause of failure in the HFNC group was aggravation of respiratory distress. While in the NIV group, the most common reason for failure was treatment intolerance. Treatment intolerance in the HFNC group was significantly lower than that in the NIV group (1.4% vs 9.4%, 95% CI 0.40-16.18; P = 0.039). Univariate logistic regression analysis showed that chronic respiratory disease, abbreviated injury scale score (chest) (≥3), Acute Physiology and Chronic Health Evaluation II score (≥15), partial arterial oxygen tension /fraction of inspired oxygen (≤200) at 1 h of treatment and respiratory rate (≥32 /min) at 1 h of treatment were risk factors associated with HFNC failure.
CONCLUSIONS: In BCT patients with mild-moderate hypoxemic ARF, the usage of HFNC did not lead to higher rate of treatment failure when compared to NIV. HFNC was found to offer better comfort and tolerance than NIV, suggesting it may be a promising new respiratory support therapy for BCT patients with mild-moderate ARF.
摘要：
目的：使用高流量鼻套管（HFNC）氧疗治疗急性呼吸衰竭（ARF）越来越受欢迎。然而,关于HFNC治疗闭合性胸外伤(BCT)患者低氧性ARF的有效性的证据有限.
方法：本回顾性分析集中于2021年1月至2022年12月在急诊内科接受HFNC或非有创通气（NIV）治疗的轻中度低氧性ARFBCT患者。主要终点是治疗失败，定义为有创通气，或切换到其他研究治疗（NFNC组患者的NIV，反之亦然)。
结果：本研究共纳入157例BCT患者（HFNC组72例，NIV组85例）。HFNC组治疗失败率为11.1%，NIV组为16.5%，风险差异为5.36%（95%CI，-5.94-16.10%；P=0.366）。HFNC组失败的最常见原因是呼吸窘迫加重。而在NIV组,失败的最常见原因是治疗不耐受.HFNC组治疗不耐受显著低于NIV组(1.4%vs9.4%,95%CI0.40-16.18；P=0.039）。单因素logistic回归分析显示,慢性呼吸系统疾病,简化损伤量表评分（胸部）（≥3），急性生理学和慢性健康评估II评分（≥15），治疗1小时的部分动脉血氧分压/吸入氧分数（≤200）和治疗1小时的呼吸频率（≥32/min）是与HFNC失败相关的危险因素。
结论：在轻度-中度低氧性ARF的BCT患者中，与NIV相比,使用HFNC并未导致更高的治疗失败率.发现HFNC比NIV提供更好的舒适度和耐受性，提示它可能是BCT轻中度ARF患者的一种有希望的新的呼吸支持疗法。
方法：本回顾性分析集中于2021年1月至2022年12月在急诊内科接受HFNC或非有创通气（NIV）治疗的轻中度低氧性ARFBCT患者。主要终点是治疗失败，定义为有创通气，或切换到其他研究治疗（NFNC组患者的NIV，反之亦然)。
结果：本研究共纳入157例BCT患者（HFNC组72例，NIV组85例）。HFNC组治疗失败率为11.1%，NIV组为16.5%，风险差异为5.36%（95%CI，-5.94-16.10%；P=0.366）。HFNC组失败的最常见原因是呼吸窘迫加重。而在NIV组,失败的最常见原因是治疗不耐受.HFNC组治疗不耐受显著低于NIV组(1.4%vs9.4%,95%CI0.40-16.18；P=0.039）。单因素logistic回归分析显示,慢性呼吸系统疾病,简化损伤量表评分（胸部）（≥3），急性生理学和慢性健康评估II评分（≥15），治疗1小时的部分动脉血氧分压/吸入氧分数（≤200）和治疗1小时的呼吸频率（≥32/min）是与HFNC失败相关的危险因素。
结论：在轻度-中度低氧性ARF的BCT患者中，与NIV相比,使用HFNC并未导致更高的治疗失败率.发现HFNC比NIV提供更好的舒适度和耐受性，提示它可能是BCT轻中度ARF患者的一种有希望的新的呼吸支持疗法。
