Effect of high-flow nasal oxygen therapy with different flow rates on respiratory mechanics after extubation in patients with invasive ventilation

doi:10.3877/cma.j.issn.2096-1537.2021.02.004

Abstract

Abstract:

Objective

To explore the effects of different flow rates under high-flow nasal cannula on the respiratory mechanics in patients with invasive ventilation after extubation, to provide reference for clinical selection.

Methods

Nine critically ill patients who admitted in the ICU of the First Affiliated Hospital of Guangzhou Medical University, from December 2018 to June 2020 underwent three different flow rate HFNC (20, 40, 60 L/min) 24-48 h after extraction. The respiratory mechanics were measured by the indwelling multifunctional monitoring nasogastric tube. The effects of HFNC with different flow rates on the respiratory mechanics were compared.

Results

Nine patients including 3 females and 6 males, with an average age of (67.2±14.1) years old were included. Diaphragm myoelectricity (EMGdi) amplitude of HFNC at 60 L/min and 40 L/min was lower than 20 L/min (P＜0.05). The esophageal pressure (Pes), gastric pressure (Pga), transdiaphragmatic pressure (Pdi), esophageal pressure-time product (PTPes), intragastric pressure-time product (PTPga), transdiaphragmatic pressure-time product (PTPdi), inspiratory time (Ti), expiratory time (Te), esophageal pressure variation rate (CVes), myoelectric variation rate (CVemg), the ratio of esophageal pressure to transdiaphragmatic pressure change (Pes/Pdi) and the ratio of transdiaphragmatic pressure-time product to esophageal pressure-time product (PTPdi/PTPes) had no significant difference at 20, 40, and 60 L/min during HFNC.

Conclusion

Choosing 20, 40, 60 L/min HFNC for sequential non-invasive adjuvant therapy after removing the artificial airway has no significant effect on respiratory mechanics. While, when the flow rate of 40 L/min, HFNC can effectively improve lung ventilation and comfort.

Key words: High-flow nasal cannula, Mechanical ventilation, Respiratory mechanics

Guangsheng Lu, Kang Wu, Shiya Wang, Zhenjie Jiang, Baozhu Zhang, Zhimin Wang, Qiang Chen, Chun Yang, Qingwen Sun, Yuanda Xu. Effect of high-flow nasal oxygen therapy with different flow rates on respiratory mechanics after extubation in patients with invasive ventilation[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2021, 07(02): 115-119.

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URL: https://icu.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2096-1537.2021.02.004

https://icu.cma-cmc.com.cn/EN/Y2021/V07/I02/115

Figures/Tables 2

对象序号	性别	年龄（岁）	体质量指数（kg/m²）	主要诊断	通气时间（d）	ICU入住时间（d）	pH	PaCO₂（mmHg）	PaO₂（mmHg）	HCO₃^- （mmol/L）
1	女	63	21.5	重症肺炎	24	35	7.452	40.0	107.0	27.5
2	男	70	16.6	重症肺炎	30	31	7.440	39.7	83.2	26.8
3	男	80	23.9	重症肺炎	8	11	7.464	35.9	116.0	26.3
4	女	65	18.0	ARDS	42	47	7.358	43.9	120.0	23.6
5	男	88	23.4	重症肺炎	10	18	7.384	56.0	67.3	32.8
6	男	46	27.7	ARDS	14	30	7.439	54.3	66.2	36.2
7	女	49	28.0	特发性肺纤维化	7	9	7.341	46.5	179.0	24.8
8	男	64	21.0	AECOPD	10	13	7.433	36.6	149.0	24.3
9	男	80	20.5	AECOPD	30	33	7.401	47.0	102.0	28.8

呼吸力学指标	不同流量HFNC			统计值	P值
呼吸力学指标	20 L/min	40 L/min	60 L/min	统计值	P值
Pes［cmH₂O，M（Q₂₅，Q₇₅）］	-4.330（-5.815，5.647）	1.087（-3.292，2.345）	0.140（-4.458，3.730）	H=1.143	0.620
Pga［cmH₂O，M（Q₂₅，Q₇₅）］	7.180（3.200，9.847）	7.778（4.052，10.801）	5.983（3.355，8.717）	H=0.672	0.715
Pdi（cmH₂O， $x ¯$ ±s）	11.943±9.508	7.570±4.713	8.683±6.311	F=0.610	0.562
PTPes［cmH₂O•s/min，M（Q₂₅，Q₇₅）］	-4.873（-7.271，5.387）	1.375（-4.253，2.410）	0.244（-4.529，5.452）	H=2.000	0.486
PTPga［cmH₂O•s/min，M（Q₂₅，Q₇₅）］	6.820（4.889，13.788）	8.999（5.885，15.780）	6.020（4.932，13.687）	H=1.143	0.620
PTPdi［cmH₂O•s/min，M（Q₂₅，Q₇₅）］	11.549（5.468，23.080）	9.272（4.299，10.717）	10.702（3.633，17.290）	H=2.333	0.430
EMGdi［μV，M（Q₂₅，Q₇₅）］	0.0623（0.0188，0.0698）	0.0597（0.0239，0.0693）^a	0.0602（0.0245，0.0714）^a	H=8.194	0.010
Ti（s， $x ¯$ ±s）	1.217±0.339	1.371±0.332	1.384±0.282	F=2.975	0.084
Te（s， $x ¯$ ±s）	1.773±0.664	1.892±0.505	2.253±0.722	F=1.044	0.382
CVes［%，M（Q₂₅，Q₇₅）］	-0.118（-0.202，0.0626）	0.131（-0.103，0.431）	0.0457（-0.129，0.609）	H=3.429	0.237
CVemg（%， $x ¯$ ±s）	0.207±0.143	0.135±0.085	0.141±0.071	F=2.505	0.117
Pes/Pdi［M（Q₂₅，Q₇₅）］	-0.367（-0.510，0.761）	0.080（-0.427，0.525）	-0.305（-2.978，0.054）	H=2.333	0.430
PTPdi/PTPes［M（Q₂₅，Q₇₅）］	-2.167（-3.821，-1.178）	1.576（-2.348，2.204）	-0.807（-3.113，14.854）	H=0.333	0.956

呼吸力学指标	不同流量HFNC			统计值	P值
呼吸力学指标	20 L/min	40 L/min	60 L/min	统计值	P值
Pes［cmH₂O，M（Q₂₅，Q₇₅）］	-4.330（-5.815，5.647）	1.087（-3.292，2.345）	0.140（-4.458，3.730）	H=1.143	0.620
Pga［cmH₂O，M（Q₂₅，Q₇₅）］	7.180（3.200，9.847）	7.778（4.052，10.801）	5.983（3.355，8.717）	H=0.672	0.715
Pdi（cmH₂O， $x ¯$ ±s）	11.943±9.508	7.570±4.713	8.683±6.311	F=0.610	0.562
PTPes［cmH₂O•s/min，M（Q₂₅，Q₇₅）］	-4.873（-7.271，5.387）	1.375（-4.253，2.410）	0.244（-4.529，5.452）	H=2.000	0.486
PTPga［cmH₂O•s/min，M（Q₂₅，Q₇₅）］	6.820（4.889，13.788）	8.999（5.885，15.780）	6.020（4.932，13.687）	H=1.143	0.620
PTPdi［cmH₂O•s/min，M（Q₂₅，Q₇₅）］	11.549（5.468，23.080）	9.272（4.299，10.717）	10.702（3.633，17.290）	H=2.333	0.430
EMGdi［μV，M（Q₂₅，Q₇₅）］	0.0623（0.0188，0.0698）	0.0597（0.0239，0.0693）^a	0.0602（0.0245，0.0714）^a	H=8.194	0.010
Ti（s， $x ¯$ ±s）	1.217±0.339	1.371±0.332	1.384±0.282	F=2.975	0.084
Te（s， $x ¯$ ±s）	1.773±0.664	1.892±0.505	2.253±0.722	F=1.044	0.382
CVes［%，M（Q₂₅，Q₇₅）］	-0.118（-0.202，0.0626）	0.131（-0.103，0.431）	0.0457（-0.129，0.609）	H=3.429	0.237
CVemg（%， $x ¯$ ±s）	0.207±0.143	0.135±0.085	0.141±0.071	F=2.505	0.117
Pes/Pdi［M（Q₂₅，Q₇₅）］	-0.367（-0.510，0.761）	0.080（-0.427，0.525）	-0.305（-2.978，0.054）	H=2.333	0.430
PTPdi/PTPes［M（Q₂₅，Q₇₅）］	-2.167（-3.821，-1.178）	1.576（-2.348，2.204）	-0.807（-3.113，14.854）	H=0.333	0.956

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