Combined lung compliance and oxygenation dynamics predict high-flow nasal cannula failure in acute respiratory distress syndrome: a retrospective cohort study.

IF 1.7 4区医学 Q3 MEDICINE, RESEARCH & EXPERIMENTAL

American journal of translational research Pub Date : 2025-06-15 eCollection Date: 2025-01-01 DOI:10.62347/ELGT2750

Huan Zhao, Ting Yao, Hong Liu

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引用次数: 0

Abstract

Objectives: To evaluate the combined predictive value of lung compliance and dynamic oxygenation parameters for high-flow nasal cannula (HFNC) outcomes.

Methods: In this single-center retrospective cohort study, 154 patients with acute respiratory distress syndrome (ARDS) treated with HFNC (flow ≥50 L/min, fraction of inspired oxygen [FiO₂] ≥0.5) between 2019 and 2022 were analyzed. Data collected included baseline characteristics, lung compliance (measured via mechanical ventilation or computed tomography [CT]), blood gas parameters-partial pressure of arterial oxygen to FiO₂ ratio (PaO₂/FiO₂) and its 24-hour change (ΔPaO₂/FiO₂) and clinical outcomes. Multivariate logistic regression and receiver operating characteristic (ROC) curve analyses were performed to identify predictors. A nomogram was constructed based on the regression model and validated using ROC curves and calibration plots.

Results: Low baseline lung compliance (<30 mL/cmH₂O) was independently associated with HFNC failure (odds ratio [OR] =3.52, 95% confidence interval [CI]: 1.92-6.45, P<0.001), as was ΔPaO₂/FiO₂<20% at 24 hours (OR=2.84, 95% CI: 1.48-5.43, P=0.002). The combined model yielded superior predictive performance (area under the curve [AUC] =0.88) compared to lung compliance (AUC=0.82) or ΔPaO₂/FiO₂ alone (AUC=0.73). The nomogram demonstrated good calibration (Hosmer-Lemeshow test, P=0.41) and potential clinical utility. Patients with HFNC failure had longer ICU stays (median 14 vs. 7 days, P<0.001) and higher complication rates, including ventilator-associated pneumonia (34.8% vs. 8.3%, P<0.001) and barotrauma (10.9% vs. 1.9%, P=0.032).

Conclusions: The combination of lung compliance and ΔPaO₂/FiO₂ improves early identification of HFNC failure and mortality risk, facilitating timely escalation to invasive ventilation. Prospective multicenter studies are needed to validate these findings.

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联合肺顺应性和氧合动力学预测急性呼吸窘迫综合征高流量鼻插管失败：一项回顾性队列研究。

目的：评价肺顺应性和动态氧合参数对高流量鼻插管（HFNC）预后的联合预测价值。方法：本研究为单中心回顾性队列研究，分析2019 - 2022年使用HFNC（流量≥50 L/min，吸入氧分数[FiO2]≥0.5）治疗的154例急性呼吸窘迫综合征（ARDS）患者。收集的数据包括基线特征、肺顺应性（通过机械通气或计算机断层扫描[CT]测量）、血气参数——动脉氧/FiO2比分压（PaO2/FiO2）及其24小时变化（ΔPaO2/FiO2）和临床结果。采用多元逻辑回归和受试者工作特征（ROC）曲线分析来确定预测因子。基于回归模型构建nomogram，并通过ROC曲线和标定图进行验证。结果：低基线肺顺应性（2O）与HFNC失败独立相关(优势比[OR] =3.52, 95%可信区间[CI]: 1.92-6.45， P2/FiO22/FiO2单独相关（AUC=0.73）。nomogram显示了良好的校准（Hosmer-Lemeshow检验，P=0.41）和潜在的临床应用价值。结论：肺顺应性和ΔPaO2/FiO2结合可提高HFNC衰竭的早期识别和死亡风险，有助于及时升级到有创通气。需要前瞻性多中心研究来验证这些发现。

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

American journal of translational research ONCOLOGY-MEDICINE, RESEARCH & EXPERIMENTAL

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552

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