背景:在COVID-19患者中,年龄较大(60岁或以上),合并症,和虚弱与较高的死亡风险和有创机械通气(IMV)失败相关.因此,建议对患有严重COVID-19肺炎和预期结局不佳的老年和脆弱患者的护理限制似乎是适当的,他们不会从侵入性治疗中受益。HFNO(高流量鼻氧气)是一种无创呼吸支持设备,已用于从头急性呼吸衰竭。这项研究的主要目的是评估在ICU(重症监护病房)外接受HFNO治疗的重症COVID-19肺炎患者的生存率,否则会出现护理限制,使他们不符合IMV的条件。次要目标是描述我们的队列和确定HFNO失败的预后因素。
方法:我们进行了一项回顾性队列研究。我们纳入了所有因护理限制而不符合IMV条件并接受HFNO治疗严重COVID-19肺炎的患者,在里昂南大学医院肺科COVID-19病房住院,法国,从2020年3月到2021年3月。主要结果是描述HFNO开始后第30天的生命状态,使用WHO(世界卫生组织)7分序数量表。
结果:纳入56例患者。中位年龄为83岁[76.3-87.0],HFNO的平均持续时间为7.5天,53%的CFS评分(临床虚弱量表)>4。在第30天,73%的患者死亡,一名患者(2%)正在接受HFNO,9%的患者出院。66%的患者发生HFNO失败。HFNO开始前呼吸衰竭的临床体征(呼吸频率>30/min,撤回,和腹部矛盾呼吸模式)与死亡率相关(p=0.001)。
结论:我们建议HFNO是非ICU技术单位的一种选择,适用于患有严重COVID-19肺炎的老年和体弱患者,否则不适合重症监护和机械通气。在开始HFNO之前观察呼吸衰竭的临床体征与死亡率相关。
BACKGROUND: In COVID-19 patients, older age (sixty or older), comorbidities, and frailty are associated with a higher risk for mortality and invasive mechanical ventilation (IMV) failure. It therefore seems appropriate to suggest limitations of care to older and vulnerable patients with severe COVID-19 pneumonia and a poor expected outcome, who would not benefit from invasive treatment.
HFNO (high flow nasal oxygen) is a non-invasive respiratory support device already used in de novo acute respiratory failure. The main objective of this study was to evaluate the survival of patients treated with
HFNO outside the ICU (intensive care unit) for a severe COVID-19 pneumonia, otherwise presenting limitations of care making them non-eligible for IMV. Secondary objectives were the description of our cohort and the identification of prognostic factors for HFNO failure.
METHODS: We conducted a retrospective cohort study. We included all patients with limitations of care making them non-eligible for IMV and treated with HFNO for a severe COVID-19 pneumonia, hospitalized in a COVID-19 unit of the pulmonology department of Lyon Sud University Hospital, France, from March 2020 to March 2021. Primary outcome was the description of the vital status at day-30 after
HFNO initiation, using the WHO (World Health Organization) 7-points ordinal scale.
RESULTS: Fifty-six patients were included. Median age was 83 years [76.3-87.0], mean duration for HFNO was 7.5 days, 53% had a CFS score (Clinical Frailty Scale) >4. At day-30, 73% of patients were deceased, one patient (2%) was undergoing HFNO, 9% of patients were discharged from hospital.
HFNO failure occurred in 66% of patients. Clinical signs of respiratory failure before
HFNO initiation (respiratory rate >30/min, retractions, and abdominal paradoxical breathing pattern) were associated with mortality (p = 0.001).
CONCLUSIONS: We suggest that HFNO is an option in non-ICU skilled units for older and frail patients with a severe COVID-19 pneumonia, otherwise non-suitable for intensive care and mechanical ventilation. Observation of clinical signs of respiratory failure before HFNO initiation was associated with mortality.