Background

High-flow nasal oxygen therapy (HFOT) is a promising first-line therapy for acute respiratory failure. However, its weaning has never been investigated and could lead to unnecessary prolonged intensive-care unit (ICU) stay. The aim of this study is to assess predictors of successful separation from HFOT in critically ill patients. We performed a retrospective monocenter observational study over a 2-year period including all patients treated with HFOT for acute respiratory failure in the ICU. Those who died or were intubated without prior HFOT separation attempt, who were treated with non-invasive ventilation at the time of HFOT separation, or who received HFOT as a preventive treatment during the post-extubation period were excluded.

Results

From the 190 patients analyzed, 168 (88%) were successfully separated from HFOT at the first attempt. Patients who failed separation from HFOT at the first attempt had longer ICU length of stay than those who succeeded: 10 days (7–12) vs. 5 (4–8), p < 0.0001. Fraction of inspired oxygen (FiO₂) ≤ 40% and a respiratory rate-oxygenation (ROX) index (calculated as the ratio of SpO₂/FiO₂ to the respiratory rate) ≥ 9.2 predicted successful separation from HFOT with sensitivity of 85% and 84%, respectively.

Conclusions

FiO₂ ≤ 40% and ROX index ≥ 9.2 were two predictors of successful separation from HFOT at the bedside. Prospective multicenter studies are needed to confirm these results.

中文翻译：

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急性呼吸衰竭患者成功地从高流量鼻氧疗法中分离的预测因素：一项回顾性单中心研究。

背景

高流量鼻氧疗法（HFOT）是用于急性呼吸衰竭的有希望的一线疗法。但是，其断奶从未进行过调查，并且可能导致不必要的长期重症监护病房（ICU）停留。这项研究的目的是评估重症患者成功从HFOT分离的预测因素。我们进行了为期2年的回顾性单中心观察性研究，其中包括所有因ICU急性呼吸衰竭而接受HFOT治疗的患者。那些在没有事先HFOT分离尝试的情况下死亡或插管的患者，在HFOT分离时接受无创通气治疗，或在拔管后接受HFOT作为预防性治疗的患者被排除在外。

结果

在首次分析的190例患者中，有168例（88％）成功与HFOT分离。首次尝试未能从HFOT分离的患者比成功者更长的ICU停留时间：10天（7–12）比5（4–8），p  <0.0001。吸氧分数（FiO ₂）≤40％，呼吸频率氧合（ROX）指数（以SpO ₂ / FiO ₂与呼吸频率的比值计算）≥9.2预测成功与HFOT分离，灵敏度为85％，分别为84％。

结论

氧合指数₂  ≤40％和ROX指数≥9.2分别在床边从HFOT成功分离的两个预测。需要进行前瞻性多中心研究以证实这些结果。