Sequential therapy with high-flow nasal cannula oxygen in patients with acute respiratory failure

doi:10.3877/cma.j.issn.2096-1537.2018.03.009

Abstract

Abstract:

Objective

To determine the efficacy of sequential therapy with high-flow nasal cannula oxygen in patients with acute respiratory failure.

Methods

Acute respiratory failure patients admitted to department of Crititcal Care Medicine of Affiliated Hospital of Nantong University who received mechanical ventilation from January 2016 to December 2017 were enrolled in this study. After extubation, 44 patients were randomly divided into control group while 45 others in high flow oxygen group. The control group was given conventional oxygen therapy (nasal catheter or mask), and high flow group was treated with high-flow nasal cannula oxygen. Respiratory rate, PaO₂/FiO₂, SaO₂ and PaCO₂ of patients at 1h, 8h and 24h after extubation between two groups were recorded. We also recorded the comfort level and tolerance of oxygen therapy, the proportion of noninvasive ventilation and re-intubation between two groups.

Results

The respiratory rate ( per minute) was significantly lower in the high-flow oxygen group [1 h: (20.6±3.2) times/min vs (24.5±3.7) times/min; 8 h: (21.5±3.6) times/min vs (20.6±3.2) times/min; 24 h: (20.9±3.4) times/min vs (24.9±4.2) times/min, all P<0.05] relative to control group. Compare to control therapy, PaO₂/FiO₂ and SaO₂ were significantly higher in the high-flow oxygen group [PaO₂/FiO₂: 1 h: (241.5±32.6) mmHg vs (213.5±30.7) mmHg; 8 h: (252.5±28.6) mmHg vs (228.1±30.7) mmHg; 24 h: (261.5±32.6) mmHg vs (230.5±30.7) mmHg; SaO₂:1 h: (96.7±3.6)% vs (92.6±4.3)%; 8 h: (96.3±3.8)% vs (93.2±4.3)%; 24 h: (96.4±3.6)% vs (93.3±3.9)%; all P<0.05]. Patients had better comfort and tolerance with high-flow nasal oxygen therapy compared to that in control group [(4.1±0.4) scores vs (3.1±0.4) scores; (3.0±0.3) scores vs (1.4±0.3) scores, all P<0.05]. In addition HFNC could reduce the needs for noninvasive ventilation (24.4% vs 45.4%, P<0.05). However, no significant differences were found in the re-intubation rate between two groups (11.1% vs 13.6%, P>0.05).

Conclusion

In patients with acute respiratory failure after extubation, treatment with high-flow oxygen can improveoxygenationwith better comfort and tolerance. Also it can reduce the use of noninvasive mechanical ventilation in patients. The findings support the use of high-flow nasal oxygen therapy as sequential therapy after extubation in patients with acute respiratory failure.

Key words: High-flow nasal cannula oxygen therapy, Acute respiratory failure, Sequential therapy

Xinlong Chen, Hongsheng Zhao, Linhua Wang, Yang Lu, Qingyun Peng. Sequential therapy with high-flow nasal cannula oxygen in patients with acute respiratory failure[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2018, 04(03): 257-261.

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Figures/Tables 5

References 14

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组别	例数	RR（次/分）	SaO₂（%）	PaO₂/FiO₂（mmHg）	PaCO₂（mmHg）
对照组	44	24.5±3.7	92.6±4.3	213.5±30.7	40.5±3.7
高流量组	45	20.6±3.2	96.7±3.6	241.5±32.6	39.7±3.6
t值	?	5.322	4.822	4.169	1.034
P值	?	<0.0001	<0.0001	<0.0001	0.3041

组别	例数	RR（次/分）	SaO₂（%）	PaO₂/FiO₂（mmHg）	PaCO₂（mmHg）
对照组	44	24.5±3.7	92.6±4.3	213.5±30.7	40.5±3.7
高流量组	45	20.6±3.2	96.7±3.6	241.5±32.6	39.7±3.6
t值	?	5.322	4.822	4.169	1.034
P值	?	<0.0001	<0.0001	<0.0001	0.3041

组别	例数	RR（次/分）	SaO₂（%）	PaO₂/FiO₂（mmHg）	PaCO₂（mmHg）
对照组	44	25.3±3.9	93.2±4.3	228.1±30.7	41.5±3.7
高流量组	45	21.5±3.6	96.3±3.8	252.5±28.6	39.9±4.1
t值	?	4.778	3.606	3.881	1.931
P值	?	<0.0001	0.0005	0.0002	0.0567

组别	例数	RR（次/分）	SaO₂（%）	PaO₂/FiO₂（mmHg）	PaCO₂（mmHg）
对照组	44	25.3±3.9	93.2±4.3	228.1±30.7	41.5±3.7
高流量组	45	21.5±3.6	96.3±3.8	252.5±28.6	39.9±4.1
t值	?	4.778	3.606	3.881	1.931
P值	?	<0.0001	0.0005	0.0002	0.0567

组别	例数	RR（次/分）	SaO₂（%）	PaO₂/FiO₂（mmHg）	PaCO₂（mmHg）
对照组	44	24.9±4.2	93.3±3.9	230.5±30.7	41.3±3.7
高流量组	45	20.9±3.4	96.4±3.6	261.5±32.6	39.7±3.6
t值	?	4.944	3.898	4.616	2.068
P值	?	<0.0001	0.0002	<0.0001	0.0516

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