BackgroundThe pathophysiological characteristics of the respiratory system of obese patients differ from those of non-obese patients. Few studies have evaluated the effects of high-flow nasal cannula (HFNC) and non-invasive ventilation (NIV) on the prognosis of obese patients. We here compared the effects of these two techniques on the prevention of reintubation after extubation for obese patients.MethodsData were extracted from the Medical Information Mart for Intensive Care database. Patients who underwent HFNC or NIV treatment after extubation were assigned to the HFNC or NIV group, respectively. The reintubation risk within 96 hours postextubation was compared between the two groups using a doubly robust estimation method. Propensity score matching was performed for both groups.ResultsThis study included 757 patients (HFNC group: n=282; NIV group: n=475). There was no significant difference in the risk of reintubation within 96 hours after extubation for the HFNC group compared with the NIV group (OR 1.50, p=0.127). Among patients with body mass index ≥40 kg/m2, the HFNC group had a significantly lower risk of reintubation within 96 hours after extubation (OR 0.06, p=0.016). No significant differences were found in reintubation rates within 48 hours (15.6% vs 11.0%, p=0.314) and 72 hours (16.9% vs 13.0%, p=0.424), as well as in hospital mortality (3.2% vs 5.2%, p=0.571) and intensive care unit (ICU) mortality (1.3% vs 5.2%, p=0.108) between the two groups. However, the HFNC group had significantly longer hospital stays (14 days vs 9 days, p=0.005) and ICU (7 days vs 5 days, p=0.001) stays.ConclusionsThis study suggests that HFNC therapy is not inferior to NIV in preventing reintubation in obese patients and appears to be advantageous in severely obese patients. However, HFNC is associated with significantly longer hospital stays and ICU stays.

BackgroundEvans' syndrome (ES) is a rare autoimmune disorder and has high mortality rate. Due to the rarity of the disease, the treatments of ES are always emprical, including steroids, IVIG, rituximab, TPO-RAs, immunosuppressants, splenectomy and supportive therapies. However, many patients may become relapsed/refractory to a series of different interventions. Herein, we report a case that a ES patient with severe refractory/relapse thrombocytopenia was successfully treated with zanubrutinib. Case presentationA 15-year-old Chinese girl, with repeated skin petechiae and ecchymosis, was diagnosed of Evans' syndrome nally. Despite the initial treatment with dexamethasone, recombinant human thrombopoietin receptor agonist (Eltrombopag /Avatrobopa), immunoglobulin, rituximab, immunosuppressants (Cyclosporine/Azathioprine /Sirolimus) and splenectomy, the patient relapsed and nally had a dramatic and lasting recovery after being treated with zanubrutinib, a second-generation selective covalent Inhibitor of Bruton's Tyrosine Kinase. ConclusionWe concluded by reviewing the cases of refractory/relapse Evans' syndrome and the application of BTK Inhibitors for the treatment of autoimmune diseases. Zanubrutinib may be a feasible therapeutic option for patients with Evans' syndrome who do not respond well to traditional therapies. Ours is the rst published case of using covalent Inhibitor of BTK in refractory/relapse Evans' syndrome and contributes to the successful use of zanubrutinib in future clinical practice. However, the role of zanubrutinib in ES treatment requires more basic and clinical trials to test and evaluate.