Predictive Factors for Tracheal Intubation in Patients with Coronavirus Disease 2019 Treated Using a High-flow Nasal Cannula

Background : In Japan, patients with coronavirus disease 2019 (COVID-19)＊ requiring a high-flow nasal cannula (HFNC) are often initially treated in non-specialized facilities and transferred to an intensive care unit if tracheal intubation is required. We aimed to investigate the factors associated with severe respiratory failure requiring tracheal intubation at an early stage in patients with COVID-19 treated using HFNCs. Methods : This retrospective cohort study compared the clinical features of consecutively enrolled patients with polymerase chain reaction-confirmed severe acute respiratory syndrome coronavirus-2 infection admitted to two centers in Japan between early February 2020 and late June 2021. Results : A total of 35 patients with COVID-19 treated using HFNCs were included. Treatment success and failure occurred in 25 and 10 patients, respectively. The oxygen saturation (ROX) index (ratio of oxygen saturation [SpO2] to fraction of inspired oxygen [FiO2] and the respiratory rate) 12 h post-HFNC insertion was a useful predictor of HFNC failure (success group, 8.0 ; failure group, 6.5 : P＝0.0005). Moreover, the time from symptom onset to respiratory failure was significantly shorter in the failure group than in the success group (3.0 and 5.0 days, P＝0.004). Conclusions The ROX index and time from symptom onset to respiratory failure were useful predictors of HFNC failure.Article信州医学雑誌 71(6) : 403-409, (2023)journal articl

Predictive Factors for Tracheal Intubation in Patients with Coronavirus Disease 2019 Treated Using a High-flow Nasal Cannula

Background : In Japan, patients with coronavirus disease 2019 (COVID-19)＊ requiring a high-flow nasal cannula (HFNC) are often initially treated in non-specialized facilities and transferred to an intensive care unit if tracheal intubation is required. We aimed to investigate the factors associated with severe respiratory failure requiring tracheal intubation at an early stage in patients with COVID-19 treated using HFNCs. Methods : This retrospective cohort study compared the clinical features of consecutively enrolled patients with polymerase chain reaction-confirmed severe acute respiratory syndrome coronavirus-2 infection admitted to two centers in Japan between early February 2020 and late June 2021. Results : A total of 35 patients with COVID-19 treated using HFNCs were included. Treatment success and failure occurred in 25 and 10 patients, respectively. The oxygen saturation (ROX) index (ratio of oxygen saturation [SpO2] to fraction of inspired oxygen [FiO2] and the respiratory rate) 12 h post-HFNC insertion was a useful predictor of HFNC failure (success group, 8.0 ; failure group, 6.5 : P＝0.0005). Moreover, the time from symptom onset to respiratory failure was significantly shorter in the failure group than in the success group (3.0 and 5.0 days, P＝0.004). Conclusions The ROX index and time from symptom onset to respiratory failure were useful predictors of HFNC failure.Article信州医学雑誌 71(6) : 403-409, (2023

Effect of multidrug therapy on the prognosis of Mycobacterium avium complex pulmonary disease

Abstract Multidrug therapy for Mycobacterium avium complex pulmonary disease (MAC-PD) results in negative sputum cultures. However, the prognostic value of this treatment approach remains unclear. This study aimed to clarify whether multidrug therapy reduces the incidence of events related to MAC-PD and improves the mortality rate. Patients who met the diagnostic criteria for MAC-PD at our hospital between 2003 and 2019 were retrospectively evaluated using medical records. Events related to MAC-PD were defined as hospitalisation for haemoptysis or respiratory infection and the development of chronic respiratory failure. There were 90 and 108 patients in the multidrug and observation groups, respectively. The median observation period was 86 months. Intergroup differences in body mass index, proportion of patients with cavities, and erythrocyte sedimentation rate were not significant. However, the observation group was older with a higher mean age (multidrug group: 62 years, observation group: 69 years; P < 0.001) and had a higher proportion of male patients (multidrug group: 13/90 [14.4%], observation group: 35/108 [32.4%]; P < 0.01). Furthermore, intergroup differences in the incidence of events related to MAC-PD (multidrug group: 26.69/1000 person-years, observation group: 25.49/1000 person-years), MAC-PD-associated mortality rate (multidrug group: 12.13/1000 person-years, observation group: 12.74/1000 person-years), and total mortality (multidrug group: 24.26/1000 person-years, observation group: 29.50/1000 person-years) were not significant. Many patients relapse even after multidrug therapy, and our findings suggest that multidrug therapy has no effect in preventing the onset of respiratory events or prolonging life expectancy