Development of a risk prediction model for high-flow nasal cannula oxygen therapy failure in acute hypoxemic respiratory failure after cardiopulmonary bypass cardiac surgery

XU Ming-xia; GENG Dan-dan; SI Lin-jie

doi:10.11659/jjssx.10E025008

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Development of a risk prediction model for high-flow nasal cannula oxygen therapy failure in acute hypoxemic respiratory failure after cardiopulmonary bypass cardiac surgery

Clinical Research | 更新时间：2026-07-31

- Development of a risk prediction model for high-flow nasal cannula oxygen therapy failure in acute hypoxemic respiratory failure after cardiopulmonary bypass cardiac surgery
- JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY Vol. 35, Issue 8, Pages: 727-731(2026)
- 作者机构：
  
  南京医科大学第一附属医院心脏大血管外科监护，江苏南京 210000
- 作者简介：
- 基金信息：
- DOI：10.11659/jjssx.10E025008
  CLC： R654.2;R563.8
- Received：09 October 2025，
  
  Online First：31 July 2026，
  
  Published：25 August 2026
- 稿件说明：
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徐明霞,耿丹丹,司林杰.体外循环心脏术后急性低氧性呼吸衰竭经鼻高流量氧疗失败的风险预测模型构建[J].局解手术学杂志,2026,35(08):727-731.

XU Ming-xia,GENG Dan-dan,SI Lin-jie.Development of a risk prediction model for high-flow nasal cannula oxygen therapy failure in acute hypoxemic respiratory failure after cardiopulmonary bypass cardiac surgery[J].JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY,2026,35(08):727-731.
徐明霞,耿丹丹,司林杰.体外循环心脏术后急性低氧性呼吸衰竭经鼻高流量氧疗失败的风险预测模型构建[J].局解手术学杂志,2026,35(08):727-731. DOI： 10.11659/jjssx.10E025008.

XU Ming-xia,GENG Dan-dan,SI Lin-jie.Development of a risk prediction model for high-flow nasal cannula oxygen therapy failure in acute hypoxemic respiratory failure after cardiopulmonary bypass cardiac surgery[J].JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY,2026,35(08):727-731. DOI： 10.11659/jjssx.10E025008.

摘要

目的

构建体外循环心脏术后急性低氧性呼吸衰竭（AHRF）患者经鼻高流量氧疗（HFNC）失败的列线图预测模型。

方法

选取2023年1月至2024年12月于我院就诊的251例体外循环心脏术后AHRF患者作为研究对象，根据HFNC情况分为HFNC失败组（

=44）和HFNC成功组（

=207）。采用单因素和多因素

Logistic

回归分析体外循环心脏术后AHRF患者HFNC失败的危险因素，并基于危险因素结果构建列线图预测模型；对该模型进行内部验证，通过校正曲线、受试者工作特征（

ROC

）曲线、决策曲线评估预测模型的区分度与临床适用性，并开发网络计算器。

结果

251例体外循环心脏术后AHRF患者中44例（17.53%）HFNC失败。年龄较大、急性生理与慢性健康状况评分Ⅱ（APACHEⅡ）评分较高、呼吸-氧合（ROX）指数较低、使用血管活性药物和脑利钠肽（BNP）水平较高是体外循环心脏术后AHRF患者HFNC失败的危险因素（

0.05）。模型验证结果显示，

index

为0.875，校准曲线趋近于理想曲线，曲线下面积（

AUC

）为0.816，在0.08~0.95预测范围内，预测模型净获益值更好。

结论

基于年龄、APACHEⅡ评分、ROX指数、血管活性药物使用情况和BNP水平构建的列线图模型预测体外循环心脏术后AHRF患者HFNC失败风险的效能较高。

Abstract

Objective

To develop a nomogram prediction model for high-flow nasal cannula therapy （HFNC）failure in patients with acute hypoxemic respiratory failure （AHRF） after cardiopulmonary bypass cardiac surgery.

Methods

A total of 251 patients with AHRF after cardiopulmonary bypass cardiac surgery admitted to our hospital from January 2023 to December 2024 were selected as the research objects.They were divided into the HFNC failure group （

=44） and the HFNC success group （

=207） according to the status of HFNC therapy.Univariate and multivariate

Logistic

regression analysis were used to identify the risk factors for HFNC failure in patients with AHRF after cardiopulmonary bypass cardiac surgery.A nomogram prediction model was constructed based on the identified risk factors. Internal validation of the model was pe

rformed.The discrimination and clinical applicability of the prediction model were evaluated by calibration curves，

receiver operating characteristic

（

ROC

）curves，and decision curve analysis.An online calculator was developed.

Results

Among the 251 patients with AHRF after cardiopulmonary bypass cardiac surgery， 44 cases （17.53%） experienced HFNC failure. Older age，higher acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ） score，lower respiratory‑oxygenation （ROX） index，use of vasoactive agents，and higher B‑type natriuretic peptide （BNP） level were identified as the risk factors for HFNC failure in these patients （

0.05）.Model validation results showed that the

index

was 0.875，the calibration curve was close to the ideal curve，and the

area under the curve

（

AUC

）was 0.816.Within the prediction range of 0.08 to 0.95，the model yielded better net benefits.

Conclusion

The nomogram model constructed based on age， APACHE Ⅱ score， ROX index，use of vasoactive agents，and BNP level exhibits high predictive efficacy for HFNC failure in patients with AHRF after cardiopulmonary bypass cardiac surgery.

关键词

Keywords

references

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