Introduction The coronavirus-19 (COVID-19) pandemic has forced radical changes in management of healthcare in military treatment facilities (MTFs). Military treatment facilities serve unique patients that have a service connection; thus, research and data on this population are relatively sparse. The purpose of this study was to provide descriptive data on characteristics and outcomes of MTF patients with COVID-19 who are treated with heated high-flow nasal cannula (HHFNC). Materials and Methods We performed a single-center retrospective cohort study at the Wright-Patterson Medical Center, a 52-bed hospital in an urban setting. We received approval from our Institutional Review Board. The cohort included patients admitted from June 1, 2020, through May 15, 2021 with severe or life-threatening COVID-19 from a positive severe acute respiratory syndrome–related coronavirus 2 reverse transcription polymerase chain reaction test who were placed on HHFNC during their hospital stay. Severe disease was defined as dyspnea, respiratory rate ≥30/min, blood oxygen saturation ≤93% without supplemental oxygen, partial pressure of arterial oxygen to fraction of inspired oxygen ratio <300, or lung infiltrates involving >50% of lung fields within 24-48 hours. Life-threatening disease was defined as having septic shock or multiple organ dysfunction or requiring intubation. Patients meeting these criteria were retrieved from a quality improvement cohort that represents a consecutive group of patients with COVID-19 admitted to the Wright-Patterson Medical Center. Results Our MTF managed 70 cases of severe or life-threatening COVID-19 from June 1, 2020, to May 15, 2021. Of the 70 cases, 19 (27%) were placed on HHFNC. After initiation of HHFNC, median SpO2/FiO2 was 281.8 and at 24 hours 145.4. Median respiratory rate oxygenation at these times were 10.7 and 9.4, respectively. Fifty percent required mechanical ventilation during hospitalization. Median intensive care unit length of stay was 11 days, with a maximum stay of 39 days. Median hospital length of stay was 12 days, with a maximum of 39 days. Conclusion Our retrospective cohort study characterized and analyzed outcomes observed in a MTF population, with severe or life-threatening COVID-19, who were treated with HHFNC. While the study did not have the power to make concrete conclusions on the optimal form of respiratory support for COVID-19 patients, our data support HHFNC as a reasonable treatment modality despite some notable differences between our cohort and prior studied patient populations.

中文翻译：

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在军事治疗机构中对严重或危及生命的 COVID-19 患者进行加热高流量鼻插管的结果——一项回顾性队列研究


简介 冠状病毒-19 (COVID-19) 大流行迫使军事治疗设施 (MTF) 的医疗保健管理发生根本性变化。军事治疗设施为具有服务联系的独特患者提供服务；因此，关于这一人群的研究和数据相对较少。本研究的目的是提供有关接受加热高流量鼻插管 (HHFNC) 治疗的 COVID-19 MTF 患者的特征和结果的描述性数据。材料和方法 我们在赖特-帕特森医学中心（Wright-Patterson Medical Center）进行了一项单中心回顾性队列研究，该中心是一家拥有 52 个床位的城市医院。我们获得了机构审查委员会的批准。该队列包括 2020 年 6 月 1 日至 2021 年 5 月 15 日期间因严重急性呼吸综合征相关冠状病毒 2 逆转录聚合酶链反应测试呈阳性而入院的严重或危及生命的 COVID-19 患者，这些患者在住院期间接受了 HHFNC 治疗停留。重度疾病定义为呼吸困难、呼吸频率≥30次/分钟、血氧饱和度≤93%（无需补充氧气）、动脉氧分压与吸入氧分数之比<300，或24小时内肺部浸润涉及>50%的肺野。 -48小时。危及生命的疾病被定义为感染性休克或多器官功能障碍或需要插管。符合这些标准的患者是从质量改进队列中检索的，该队列代表赖特-帕特森医疗中心收治的连续一组 COVID-19 患者。结果 从 2020 年 6 月 1 日至 2021 年 5 月 15 日，我们的 MTF 管理了 70 例严重或危及生命的 COVID-19 病例。在这 70 例病例中，19 例 (27%) 被安排在 HHFNC 治疗。开始 HHFNC 后，中位 SpO2/FiO2 为 281。8、24小时145.4。这些时间的中位呼吸频率氧合分别为 10.7 和 9.4。百分之五十在住院期间需要机械通气。重症监护室住院时间中位数为 11 天，最长住院时间为 39 天。住院时间中位数为 12 天，最长为 39 天。结论 我们的回顾性队列研究描述并分析了接受 HHFNC 治疗的严重或危及生命的 COVID-19 的 MTF 人群中观察到的结果。虽然该研究无法就 COVID-19 患者的最佳呼吸支持形式得出具体结论，但我们的数据支持 HHFNC 作为一种合理的治疗方式，尽管我们的队列与之前研究的患者群体之间存在显着差异。