Influencing factors and predictors of weaning from high-flow nasal cannula oxygen therapy in patients with pneumonia-related respiratory failure
ZHENG Jian1, 2, HUANG Shu’e1, WANG Xuetao3, WANG Liangxing2
1.Department of Critical Medicine, Wenzhou Integrated Traditional Chinese and Western Medicine Hospital, Wenzhou 325000, China; 2.Department of Respiratory Medicine, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325015, China; 3.Department of Critical Medicine, Wenzhou Longwan First People’s Hospital, Wenzhou 325024, China.
ZHENG Jian,HUANG Shu’e,WANG Xuetao, et al. Influencing factors and predictors of weaning from high-flow nasal cannula oxygen therapy in patients with pneumonia-related respiratory failure[J]. JOURNAL OF WEZHOU MEDICAL UNIVERSITY, 2021, 51(9): 729-734.
Abstract：Objective: To study the influencing factors of weaning from high-flow nasal cannula oxygen therapy (HFNC) in patients with pneumonia-related respiratory failure during the recovery phase and to find the ideal predictors. Methods: Retrospective analysis was performed on 159 patients with pneumonia-associated respiratory failure treated with HFNC in the intensive care unit of Wenzhou Integrated Traditional Chinese and Western Medicine Hospital from January 2018 to December 2020. According to whether reapplication of the HFNC or mechanical ventilation was required within 48 h of conversion to conventional oxygen therapy after weaning from HFNC, they were divided into the successful group and the failure group. Then the two groups were compared in the baseline characteristics, comorbidities, pneumonia typing, machine setup parameters,physiological parameters, laboratory indexes, drugs used, treatment duration, ROX index (SpO2/FiO2 divided by respiratory rate) at the time of the patient’s first attempt to disengage from HFNC treatment, and treatment modality after weaning from HFNC. Logistic regression analyses were used to determine independent influencing factors and the value of the indicators was analyzed. Results: The number of patients successfully weaned from HFNC at the first attempt was 128, while 31 patients failed to wean. The logistic regression analysis showed that FiO2,ROX index, and combined chronic heart failure were independent influencing factors of successful weaning from HFNC (P<0.05). The ROX index was used to build a model for predicting successful HFNC disengagement with an AUROC of 0.836, with an optimal threshold point of 9.9, sensitivity of 93.0%, and specificity of 64.5%. The ROX index outperformed the FiO2 in comparison of the model’s predictive efficacy, sensitivity, and specificity.Conclusion: FiO2, ROX index, and combined chronic heart failure were independent influencing factors of successful weaning from HFNC in patients with pneumonia-related respiratory failure. And the ROX index was more valuable than FiO2 in predicting successful weaning from HFNC in patients with pneumonia-related respiratory failure.
