ABSTRACT
Objective:To explore the pros and cons of sequential high-flow nasal cannula (HFNC) and non-invasive positive pressure ventilation (NIPPV) immediately following early extubated patients with severe respiratory failure (SRF) due to acute exacerbations of chronic obstructive pulmonary disease (AECOPD), so as to provide evidence for clinical selection of optimal scheme.Methods:Consecutive AECOPD patients admitted to the respiratory intensive care unit (RICU) of the First Affiliated Hospital of Xinjiang Medical University from January 2019 to September 2020 were screened for enrollment. Patients were between 40 years old and 85 years old with acute exacerbation of bronchial-pulmonary infection, who received endotracheal intubation mechanical ventilation (ETI-MV) as the initial respiratory support method. The pattern of synchronous intermittent mandatory ventilation (SIMV) was used in the study. The parameters were set as follows: tidal volume (VT) 8 mL/kg, support pressure 10-15 cmH 2O (1 cmH 2O = 0.098 kPa), positive end-expiratory pressure (PEEP) 4-6 cmH 2O and the ratio of inspiratory to expiratory time 1.5-2.5∶1. Under these conditions, the plateau pressure (Pplat) was maintained less than 30 cmH 2O. The minimum fraction of inspired oxygen was adjusted to keep the pulse oxygen saturation no less than 0.92. When the pulmonary infection control window (PIC window) occurred, the subjects were extubated immediately and randomly divided into two groups, with one group receiving HFNC (called HFNC group), the other group receiving NIPPV (called NIPPV group). Patients with failed sequential HFNC or NIPPV underwent tracheal re-intubation. The rate of tracheal re-intubation within 7 days of extubation, complications (such as nose and face crush injury and gastric distension), in-hospital mortality, duration of ETI before PIC window, length of RICU stay and length of hospital stay were compared, respectively. Results:Forty-four patients were enrolled in the study, 20 in the HFNC group and 24 in the NIPPV group. There was no significant difference in the duration of ETI before PIC window between HFNC and NIPPV groups (hours: 95.9±13.1 vs. 91.8±20.4, P > 0.05). The rate of tracheal re-intubation within 7 days in the HFNC group was significantly higher than that in the NIPPV group [35.0% (7/20) vs. 4.2 % (1/24), P < 0.05]. However, the incidence of complication in the HFNC group was significantly lower than that in the NIPPV group [0% (0/20) vs. 25.0% (6/24), P < 0.05]. Compared with the NIPPV group, the in-hospital mortality in the HFNC group was slightly higher [5.0% (1/20) vs. 4.2% (1/24)], the length of RICU stay (days: 19.5±10.8 vs. 15.5±7.2) and the length of hospital stay (days: 27.4±12.2 vs. 23.3±10.9) were slightly longer, without statistical differences (all P > 0.05). Conclusion:For early extubated patients with SRF due to AECOPD, the compliance of sequential HFNC increased and the complications decreased significantly, but the final effect may be worse than sequential NIPPV.
ABSTRACT
Objective To evaluate the clinical effect of buccal administration of Kangfuxin Liquid combined with conventional treatment for infantile herpetic stomatitis. Method A total of 103 infantiles with herpetic stomatitis were randomly divided into a Kangfuxin group (51 cases) and a conventional group (52 cases). The conventional group received ribavirin aerosol, and the Kangfuxin group recived buccal administration of Kangfuxin Liquid based on the intervention of convertional group. All children were treated for 5 days. The white blood cell count (WBC) and the serum C-reactive protein (CRP) were determined. Result The total efficiency rate in the Kangfuxin group was significantly higher than that in the conventional group (94.1% vs. 78.8%,χ2=3.895, P<0.05). The healing time of oral ulcers (5.8 ± 1.3 d vs. 7.9 ± 1.5 d, t=10.715), body temperature recovery time (2.1 ± 1.1 d vs. 3.3 ± 1.5 d, t=4.623), and eliminating time of oral mucosal hyperemia and edema (4.3 ± 1.3 d vs. 5.3 ± 1.4 d, t=3.755) in the Kangfuxin group was significantly shorter than those in the conventional treatment group (P<0.01). The WBC (6.5×109 ± 2.2×109/L vs. 9.4×109 ± 2.3×109/L, t=6.537) and serum CRP levels (6.7 ± 1.2 mg/L vs. 9.7 ± 2.5 mg/L, t=12.686) were significantly lower in the Kangfuxin group was significantly lower than those in the conventional treatment group (P<0.01). Conclusions The total efficiency rate of buccal administration of Kangfuxin Liquid combined with conventional treatment for infantile herpetic stomatitis was higher than conventional treatment alone. And the remission time of symptoms of treatment group was shorter.