{"title":"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。","authors":"Huan Zhao, Ting Yao, Hong Liu","doi":"10.62347/ELGT2750","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the combined predictive value of lung compliance and dynamic oxygenation parameters for high-flow nasal cannula (HFNC) outcomes.</p><p><strong>Methods: </strong>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 [FiO<sub>2</sub>] ≥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 FiO<sub>2</sub> ratio (PaO<sub>2</sub>/FiO<sub>2</sub>) and its 24-hour change (ΔPaO<sub>2</sub>/FiO<sub>2</sub>) 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.</p><p><strong>Results: </strong>Low baseline lung compliance (<30 mL/cmH<sub>2</sub>O) was independently associated with HFNC failure (odds ratio [OR] =3.52, 95% confidence interval [CI]: 1.92-6.45, P<0.001), as was ΔPaO<sub>2</sub>/FiO<sub>2</sub><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 ΔPaO<sub>2</sub>/FiO<sub>2</sub> 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).</p><p><strong>Conclusions: </strong>The combination of lung compliance and ΔPaO<sub>2</sub>/FiO<sub>2</sub> improves early identification of HFNC failure and mortality risk, facilitating timely escalation to invasive ventilation. Prospective multicenter studies are needed to validate these findings.</p>","PeriodicalId":7731,"journal":{"name":"American journal of translational research","volume":"17 6","pages":"4175-4186"},"PeriodicalIF":1.6000,"publicationDate":"2025-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12261171/pdf/","citationCount":"0","resultStr":"{\"title\":\"Combined lung compliance and oxygenation dynamics predict high-flow nasal cannula failure in acute respiratory distress syndrome: a retrospective cohort study.\",\"authors\":\"Huan Zhao, Ting Yao, Hong Liu\",\"doi\":\"10.62347/ELGT2750\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>To evaluate the combined predictive value of lung compliance and dynamic oxygenation parameters for high-flow nasal cannula (HFNC) outcomes.</p><p><strong>Methods: </strong>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 [FiO<sub>2</sub>] ≥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 FiO<sub>2</sub> ratio (PaO<sub>2</sub>/FiO<sub>2</sub>) and its 24-hour change (ΔPaO<sub>2</sub>/FiO<sub>2</sub>) 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.</p><p><strong>Results: </strong>Low baseline lung compliance (<30 mL/cmH<sub>2</sub>O) was independently associated with HFNC failure (odds ratio [OR] =3.52, 95% confidence interval [CI]: 1.92-6.45, P<0.001), as was ΔPaO<sub>2</sub>/FiO<sub>2</sub><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 ΔPaO<sub>2</sub>/FiO<sub>2</sub> 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).</p><p><strong>Conclusions: </strong>The combination of lung compliance and ΔPaO<sub>2</sub>/FiO<sub>2</sub> improves early identification of HFNC failure and mortality risk, facilitating timely escalation to invasive ventilation. Prospective multicenter studies are needed to validate these findings.</p>\",\"PeriodicalId\":7731,\"journal\":{\"name\":\"American journal of translational research\",\"volume\":\"17 6\",\"pages\":\"4175-4186\"},\"PeriodicalIF\":1.6000,\"publicationDate\":\"2025-06-15\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12261171/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"American journal of translational research\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.62347/ELGT2750\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"Q3\",\"JCRName\":\"MEDICINE, RESEARCH & EXPERIMENTAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"American journal of translational research","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.62347/ELGT2750","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q3","JCRName":"MEDICINE, RESEARCH & EXPERIMENTAL","Score":null,"Total":0}
Combined lung compliance and oxygenation dynamics predict high-flow nasal cannula failure in acute respiratory distress syndrome: a retrospective cohort study.
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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