High-Flow Nasal Cannula versus Noninvasive Ventilation in AECOPD Patients with Respiratory Acidosis: A Retrospective Propensity Score-Matched Study.

IF 2.1 4区医学 Q3 RESPIRATORY SYSTEM Canadian respiratory journal Pub Date : 2023-04-15 eCollection Date: 2023-01-01 DOI:10.1155/2023/6377441

Meng Wang, Feifan Zhao, Lina Sun, Ying Liang, Wei Yan, Xiaoyan Sun, Qingtao Zhou, Bei He

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Abstract

Background: Limited data are available about the clinical outcomes of AECOPD patients with respiratory acidosis treated with HFNC versus NIV.

Methods: We conducted a retrospective study to compare the efficacy of HFNC with NIV as initial ventilation support strategy in AECOPD patients with respiratory acidosis. Propensity score matching (PSM) was implemented to increase between-group comparability. Kaplan-Meier analysis was utilized to evaluate differences between the HFNC success, HFNC failure, and NIV groups. Univariate analysis was performed to identify the features that differed significantly between the HFNC success and HFNC failure groups.

Results: After screening 2219 hospitalization records, 44 patients from the HFNC group and 44 from the NIV group were successfully matched after PSM. The 30-day mortality (4.5% versus 6.8%, p = 0.645) and 90-day mortality (4.5% versus 11.4%, p = 0.237) did not differ between the HFNC and NIV groups. Length of ICU stay (median: 11 versus 18 days, p = 0.001), length of hospital stay (median: 14 versus 20 days, p = 0.001), and hospital cost (median: 4392 versus 8403 $USD, p = 0.001) were significantly lower in the HFNC group compared with NIV group. The treatment failure rate was much higher in the HFNC group than in the NIV group (38.6% versus 11.4%, p = 0.003). However, patients who experienced HFNC failure and switched to NIV showed similar clinical outcomes to those who first received NIV. Univariate analysis showed that log NT-proBNP was an important factor for HFNC failure (p = 0.007).

Conclusions: Compared with NIV, HFNC followed by NIV as rescue therapy may be a viable initial ventilation support strategy for AECOPD patients with respiratory acidosis. NT-proBNP may be an important factor for HFNC failure in these patients. Further well-designed randomized controlled trials are needed for more accurate and reliable results.

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呼吸性酸中毒 AECOPD 患者的高流量鼻导管与无创通气：倾向评分匹配的回顾性研究。

背景：有关呼吸性酸中毒 AECOPD 患者接受高频通气与 NIV 治疗的临床结果的数据有限：我们进行了一项回顾性研究，以比较 HFNC 和 NIV 作为呼吸性酸中毒 AECOPD 患者初始通气支持策略的疗效。为了增加组间可比性，我们采用了倾向评分匹配法（PSM）。采用 Kaplan-Meier 分析法评估 HFNC 成功组、HFNC 失败组和 NIV 组之间的差异。进行单变量分析以确定在 HFNC 成功组和 HFNC 失败组之间存在显著差异的特征：结果：在筛选了 2219 份住院病历后，44 名 HFNC 组和 44 名 NIV 组患者经过 PSM 成功配对。HFNC 组和 NIV 组的 30 天死亡率（4.5% 对 6.8%，p = 0.645）和 90 天死亡率（4.5% 对 11.4%，p = 0.237）没有差异。与 NIV 组相比，HFNC 组的重症监护室住院时间（中位数：11 天对 18 天，p = 0.001）、住院时间（中位数：14 天对 20 天，p = 0.001）和住院费用（中位数：4392 美元对 8403 美元，p = 0.001）显著减少。HFNC 组的治疗失败率（38.6% 对 11.4%，P = 0.003）远高于 NIV 组。不过，HFNC 治疗失败后转为 NIV 治疗的患者与首次接受 NIV 治疗的患者的临床结果相似。单变量分析显示，对数 NT-proBNP 是导致 HFNC 失败的重要因素（p = 0.007）：结论：与 NIV 相比，对于呼吸性酸中毒的 AECOPD 患者来说，HFNC 后 NIV 作为抢救疗法可能是一种可行的初始通气支持策略。NT-proBNP 可能是导致这些患者 HFNC 失败的一个重要因素。要获得更准确、更可靠的结果，还需要进一步开展设计良好的随机对照试验。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Canadian respiratory journal 医学-呼吸系统

CiteScore

4.20

自引率

0.00%

发文量

审稿时长

6-12 weeks

期刊介绍： Canadian Respiratory Journal is a peer-reviewed, Open Access journal that aims to provide a multidisciplinary forum for research in all areas of respiratory medicine. The journal publishes original research articles, review articles, and clinical studies related to asthma, allergy, COPD, non-invasive ventilation, therapeutic intervention, lung cancer, airway and lung infections, as well as any other respiratory diseases.