Combined lung compliance and oxygenation dynamics predict high-flow nasal cannula failure in acute respiratory distress syndrome: a retrospective cohort study
Year: 2025
Type: article
Study design: Observational Study
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 [FiO 2 ] ≥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 2 ratio (PaO 2 /FiO 2 ) and its 24-hour change (ΔPaO 2 /FiO 2 ) 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/cmH 2 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 2 /FiO 2 <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 2 /FiO 2 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 ΔPaO 2 /FiO 2 improves early identification of HFNC failure and mortality risk, facilitating timely escalation to invasive ventilation.Prospective multicenter studies are needed to validate these findings.
DOI: 10.62347/elgt2750
Author: Huan Zhao
Institution: Jinzhou Medical University
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4411842664