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Objective:To investigate the application value of ROX index in evaluating the effect of high-flow nasal cannula oxygen therapy (HFNC) on patients diagnosed with respiratory failure, and to find a simpler and more effective method to observe the efficacy of HFNC.Methods:A retrospective cohort study was conducted. Patients who were admitted to department of critical care medicine of the Tianjin Third Central Hospital from April 2020 to August 2022, diagnosed with type Ⅰ respiratory failure, and treated with HFNC after failure of conventional oxygen therapy were enrolled. Oxygenation index (PaO 2/FiO 2), fraction of inspired oxygen (FiO 2), gas flow rate at the initial time of admission, and pulse oxygen saturation (SpO 2), FiO 2 and respiratory rate (RR) at 2, 4, 6, 8, 10 and 12 hours of HFNC were collected, and ROX index was calculated. The patients with symptoms and PaO 2/FiO 2 improved after HFNC treatment and without higher respiratory support lately were defined as HFNC success, while other patients with symptoms worsening and needing follow-up non-invasive positive pressure ventilation (NIPPV) or invasive positive pressure ventilation (IPPV) were defined as HFNC failure. The tendency of changes in the ROX index at each time point was observed. Receiver operator characteristic curve (ROC curve) was plotted to obtain the optimum cut-off value of ROX index for predicting HFNC outcome and the optimal monitoring time point for HFNC. Results:A total of 142 patients were eventually enrolled, among whom 96 patients (67.61%) were in treated with HFNC successfully, while 46 patients (32.39%) were recorded as HFNC failure (39 patients and 7 patients received NIPPV or IPPV, respectively), with an overall intubation rate of 4.93% (7/142). Compared with the HFNC success group, the HFNC failure group had lower PaO 2/FiO 2 [mmHg (1 mmHg ≈ 0.133 kPa): 208.8±37.3 vs. 235.7±48.3, P < 0.01] and higher initial gas flow rate (L/min: 46.4±3.9 vs. 42.3±4.9, P < 0.01). However, there was no significant difference in gender, age, primary diagnosis, severity of disease, hemoglobin (Hb), C-reactive protein (CRP), and brain natriuretic peptide (BNP) between the two groups. In the HFNC failure group, there were 12 patients (26.09%) received progressive oxygen therapy within 12 hours of HFNC, of which 3 patients (6.52%) occurred within 6 hours, while the other 9 patients (19.57%) occurred after 6 hours. The initial ROX index was not statistically significant between the two groups. Both groups showed a continuous increasing ROX index with longer treatment duration of HFNC, and the ROX index at all of the time points of the HFNC failure group was significantly lower than that of the HFNC success group with statistically significant difference (2 hours: 9.39±2.85 vs. 10.91±3.51, 4 hours: 8.62±2.29 vs. 11.40±3.18, 6 hours: 7.62±1.65 vs. 11.85±3.45, 8 hours: 7.79±1.59 vs. 11.62±3.10, 10 hours: 7.97±1.62 vs. 12.44±2.75, 12 hours: 8.84±2.51 vs. 12.45±3.03, all P < 0.05). The ROC curve analysis showed that the areas under the ROC curve (AUC) of ROX index assessing the effect of HFNC at the time of treating 6, 8 and 10 hours were better than 2, 4 and 12 hours (0.890, 0.903, 0.930 vs. 0.585, 0.738 and 0.829), indicating that the ROX index could determine the efficacy at the early stage of HFNC (within 6 hours). When the optimum cut-off value of ROX index was 8.78, the sensitivity was 90.6%, and the specificity was 76.5%. Conclusion:The ROX index at 6 hours of HFNC has a certain predictive value for the efficacy of HFNC with an optimum cut-off value of 8.78, which can provide clinical health care personnel a method for observing the efficacy of HFNC, and guide the correct selection of oxygen therapy modality at an early stage and timely adjustment of oxygen therapy strategy.
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Objective:To explore the effects of different initial flow rates of humidified high flow nasal cannula oxygen therapy on weaning outcomes and comfort level among ICU patients with difficult weaning.Methods:A total of 99 ICU patients with difficult weaning received at Guangzhou Red Cross Hospital ICU from June 2019 to June 2021 were enrolled in the present study, they were assigned to 40 L/min group, 50 L/min group and 60 L/min group according to the random number table method, with 33 cases in each group. The weaning outcomes among three groups were compared, the degree of dryness of oral/nasal cavity, throat pain as well as vital signs and blood gas indexes were also compared before extubation and 30 min after the first humidified high flow nasal cannula (HHFNC) oxygen therapy.Results:There was no significant difference in length of stay in ICU and hospital, re-intubation within 7 days, the mortality within 28 days in ICU and the hospital among three groups ( P>0.05). The weaning success rate were 78.8% (24/33) and 77.4% (23/31) in 50 L/min group and 60 L/min, higher than in the 40 L/min group 53.1% (17/32), the difference was statistically significant ( χ2=4.78, 4.09, both P<0.05). After oxygen therapy, the scores of dryness of oral/nasal cavity and throat pain in the 40 L/min group, 50 L/min group and 60 L/min group were (3.16 ± 0.77), (2.94 ± 0.80) and (3.27 ± 0.92), (3.09 ± 0.77), and (4.10 ± 1.01), (3.97 ± 1.40), the differences were statistically significant ( F=5.21, 9.26, both P<0.05), and the differences between 50 L/min group and 40 L/min group and 60 L/min group were statistically significant ( t values were 2.62-3.99, all P<0.05). However, there was no significant difference in vital signs and blood gas indexes among the three groups before extubation and after oxygen therapy ( P>0.05). Conclusions:Humidified high flow nasal cannula oxygen therapy for the ICU patients with difficult weaning, oxygen flow with 50L/min can not only effectively promote weaning success rate but also improve patients′ respiratory comfort level.
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Objective:To compare the efficacy of high-flow nasal cannula oxygen therapy (HFNC) and non-invasive ventilation (NIV) in the treatment of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with moderate typeⅡ respiratory failure, to clarify the feasibility of HFNC in the treatment of AECOPD, and to explore the influencing factors of HFNC failure.Methods:This study was a randomized controlled trial of non-inferiority. Patients with AECOPD with moderate type Ⅱ respiratory failure [arterial blood gas pH 7.25-7.35, partial pressure of arterial blood carbon dioxide (PaCO 2)> 50 mmHg] admitted to the Intensive Care Unit (ICU) from January 2018 to December 2021 were randomly assigned to the HFNC group and NIV group to receive respiratory support. The primary endpoint was the treatment failure rate. The secondary endpoints were blood gas analysis and vital signs at 1 h, 12 h, and 48 h, total duration of respiratory support, 28-day mortality, comfort score, ICU length of stay, and total length of stay. Multivariate logistic regression analysis was used to evaluate the failure factors of HFNC treatment. Results:Totally 228 patients were randomly divided into two groups, 108 patients in the HFNC group and 110 patients in the NIV group. The treatment failure rate was 29.6% in the HFNC group and 25.5% in the NIV group. The risk difference of failure rate between the two groups was 4.18% (95% CI: -8.27%~16.48%, P=0.490), which was lower than the non-inferiority value of 9%. The most common causes of failure in the HFNC group were carbon dioxide retention and aggravation of respiratory distress, and the most common causes of failure in the NIV group were treatment intolerance and aggravation of respiratory distress. Treatment intolerance in the HFNC group was significantly lower than that in the NIV group (-29.02%, 95% CI -49.52%~-7.49%; P=0.004). After 1 h of treatment, the pH in both groups increased significantly, PaCO 2 decreased significantly and the oxygenation index increased significantly compared with baseline (all P < 0.05). PaCO 2 in both groups decreased gradually at 1 h, 12 h and 48 h after treatment, and the pH gradually increased. The average number of daily airway care interventions and the incidence of nasal and facial lesions in the HFNC group were significantly lower than those in the NIV group ( P < 0.05), while the comfort score in the HFNC group was significantly higher than that in the NIV group ( P=0.021). There was no significant difference between the two groups in the total duration of respiratory support, dyspnea score, ICU length of stay, total length of stay and 28-day mortality (all P > 0.05). Multivariate logistic regression analysis showed that acute physiology and chronic health evaluation Ⅱ score (≥15), family NIV, history of cerebrovascular accident, PaCO 2 (≥60 mmHg) and respiratory rate (≥32 times/min) at 1 h were independent predictors of HFNC failure. Conclusions:HFNC is not inferior to NIV in the treatment of AECOPD complicated with moderate type Ⅱ respiratory failure. HFNC is an ideal choice of respiratory support for patients with NIV intolerance, but clinical application should pay attention to the influencing factors of its treatment failure.
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Objective:To observe the effect of noninvasive positive pressure ventilation (NIPPV) and high-flow nasal cannula oxygen therapy (HFNC) on the prognosis of patients with coronavirus disease 2019 (COVID-19) accompanied with acute respiratory distress syndrome (ARDS).Methods:A retrospective study was conducted in Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology when authors worked as medical team members for treating COVID-19. COVID-19 patients with pulse oxygen saturation/fraction of inspiration oxygen (SpO 2/FiO 2, S/F) ratio < 235, managed by medical teams [using S/F ratio instead of oxygenation index (PaO 2/FiO 2) to diagnose ARDS] from February to April 2020 were included. The patients were divided into NIPPV group and HFNC group according to their oxygen therapy modes. Clinical data of patients were collected, including general characteristics, respiratory rate (RR), fraction of FiO 2, SpO 2, heart rate (HR), mean arterial pressure (MAP), S/F ratio in the first 72 hours, lymphocyte count (LYM), percentage of lymphocyte (LYM%) and white blood cell count (WBC) at admission and discharge or death, the duration of dyspnea before NIPPV and HFNC, and the length from onset to admission. The differences of intubation rate, all-cause mortality, S/F ratio and RR were analyzed, and single factor analysis and generalized estimation equation (GEE) were used to analyze the risk factors affecting S/F ratio. Results:Among the 41 patients, the proportion of males was high (68.3%, 28 cases), the median age was 68 (58-74) years old, 28 cases had complications (68.3%), and 34 cases had multiple organ dysfunction syndrome (MODS, 82.9%). Compared with HFNC group, the proportion of complications in NIPPV group was higher [87.5% (21/24) vs. 41.2% (7/17), P < 0.05], and the value of LYM% was lower [5.3% (3.4%-7.8%) vs. 10.0% (3.9%-19.7%), P < 0.05], the need of blood purification was also significantly lower [0% (0/24) vs. 29.4% (5/17), P < 0.05]. The S/F ratio of NIPPV group gradually increased after 2 hours treatment and RR gradually decreased with over time, S/F ratio decreased and RR increased in HFNC group compared with baseline, but there was no significant difference in S/F ratio between the two groups at each time point. RR in NIPPV group was significantly higher than that in HFNC group after 2 hours treatment [time/min: 30 (27-33) vs. 24 (21-27), P < 0.05]. There was no significant difference in rate need intubation and hospital mortality between NIPPV group and HFNC group [66.7% (16/24) vs. 70.6% (12/17), 58.3% (14/24) vs. 52.9% (9/17), both P > 0.05]. Analysis of the factors affecting the S/Fratio in the course of oxygen therapy showed that the oxygen therapy mode and the course of illness at admission were the factors affecting the S/F ratio of patients [ β values were -15.827, 1.202, 95% confidence interval (95% CI) were -29.102 to -2.552 and 0.247-2.156, P values were 0.019 and 0.014, respectively]. Conclusion:Compared with HFNC, NIPPV doesn't significantly reduce the intubation rate and mortality of patients with COVID-19 accompanied with ARDS, but it significantly increases the S/F ratio of those patients.
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Objective:To observe the application effect of high-flow nasal canula oxygen therapy (HFNC) after extubation in patients with mechanical ventilation (MV) in the intensive care unit (ICU).Methods:A prospective study was conducted. From January 2018 to June 2020, 163 MV patients admitted to Yijishan Hospital of Wannan Medical College were enrolled, and they were divided into HFNC group (82 cases) and traditional oxygen therapy group (81 cases) according to the oxygen therapy model. The patients included in the study were given conventional treatment according to their condition. In the HFNC group, oxygen was inhaled by a nasal high-flow humidification therapy instrument. The gas flow was gradually increased from 35 L/min to 60 L/min according to the patient's tolerance, and the temperature was set at 34-37 ℃. The fraction of inspiration oxygen (FiO 2) was set according to the patient's pulse oxygen saturation (SpO 2) and SpO 2 was maintained at 0.95-0.98. A disposable oxygen mask or nasal cannula was used to inhale oxygen in the traditional oxygen therapy group, and the oxygen flow was 5-8 L/min, maintaining the patient's SpO 2 at 0.95-0.98. The differences in MV duration before extubation, total MV duration, intubation time, reintubation time, extubation failure rate, ICU mortality, ICU stay, and in-hospital stay were compared between the two groups, and weaning failure were analyzed. Results:There was no significant differences in MV duration before extubation (days: 4.33±3.83 vs. 4.15±3.03), tracheal intubation duration (days: 4.34±1.87 vs. 4.20±3.35), ICU mortality [4.9% (4/82) vs. 3.7% (3/81)] and in-hospital stay [days: 28.93 (15.00, 32.00) vs. 27.69 (15.00, 38.00)] between HFNC group and traditional oxygen therapy group (all P > 0.05). The total MV duration in the HFNC group (days: 4.48±2.43 vs. 5.67±3.84) and ICU stay [days: 6.57 (4.00, 7.00) vs. 7.74 (5.00, 9.00)] were significantly shorter than those in the traditional oxygen therapy group, the reintubation duration of the HFNC group was significantly longer than that of the traditional oxygen therapy group (hours: 35.75±10.15 vs. 19.92±13.12), and the weaning failure rate was significantly lower than that of the traditional oxygen therapy group [4.9% (4/82) vs. 16.0% (13/81), all P < 0.05]. Among the reasons for weaning failure traditional oxygen therapy group had lower ability of airway secretion clearance than that of the HFNC group [8.64% (7/81) vs. 0% (0/82), P < 0.05], there was no statistically differences in the morbidity of heart failure, respiratory muscle weakness, hypoxemia, and change of consciousness between the two groups. Conclusion:For MV patients in the ICU, the sequential application of HFNC after extubation can reduce the rate of weaning failure and the incidence of adverse events, shorten the length of ICU stay.
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Objective:To observe the effect of high-flow nasal cannula oxygen therapy (HFNC) in patients with chronic obstructive pulmonary disease (COPD) and mild hypercapnia, and to evaluate the early predictive ability of physiological parameters in these patients.Methods:A retrospective cohort study was conducted based on Medical Information Mart for Intensive Care-Ⅳ (MIMIC-Ⅳ) updated in September 2020 and the data of adult patients with COPD and mild hypercapnia [45 mmHg (1 mmHg = 0.133 kPa) < arterial partial pressure of carbon dioxide (PaCO 2)≤ 60 mmHg] from 2008 to 2019 were collected. These patients were assigned to the HFNC group or non-invasive ventilation (NIV) group according to whether they received HFNC or NIV. Baseline data such as gender, age, body mass index (BMI), simplified acute physiology scoreⅡ (SAPSⅡ), Charlson comorbidity index (CCI) and physiological parameters were collected. A propensity score matching was conducted according to the baseline data of the HFNC group patients. The 48-hour and 28-day intubation rates, 28-day mortality, length of intensive care unit (ICU) stay, the length of hospital stay, and the changes in physiological parameters within 48 hours after treatment were compared between the two groups. The receiver operating characteristic curve (ROC curve) was drawn and the ratio of heart rate over pulse oxygen saturation (HR/SpO 2) and ROX index [SpO 2 / (inhaled oxygen concentration, FiO 2×respiratory rate, RR)] were analyzed to predict the 24-hour and 48-hour intubation rates. Results:A total of 524 520 inpatient records were screened and 153 patients were included, while 37 patients in the HFNC group and 116 patients in NIV group. There were 31 patients in the HFNC group and 84 patients in the NIV group remained after propensity score matching according to the baseline data. There were no significant differences in the baseline data of gender, age, BMI, SAPSⅡ, CCI score, physiological parameters and prognosis data except the length of ICU stay. The length of ICU stay in HFNC group was significant longer than that of the NIV group [days: 4.6 (3.1, 10.0) vs. 3.1 (1.6, 5.8), P < 0.05]. HR and RR at 40- 48 hours were significantly lower than those at 0-8 hours after treatment only in the HFNC group [HR (bpm): 84.1±12.2 vs. 91.1±16.4, RR (times/min): 19.8±4.9 vs. 21.6±4.1, both P < 0.05]. Both in the HFNC group and NIV group the pH increased (7.42±0.08 vs. 7.36±0.05 and 7.41±0.06 vs. 7.36±0.05, both P < 0.05) and PaCO 2 decreased significantly [mmHg: 46.3 (39.5, 51.0) vs. 49.8 (45.5, 54.0) and 46.0 (40.5, 51.5) vs. 49.5 (45.5, 55.3), both P < 0.05]. The HR, PaO 2 were higher in the HFNC group than those in the HFNC group at 40-48 hours after treatment [HR (bpm): 91.1±15.4 vs. 84.1±12.2, PaO 2 (mmHg): 99.5 (86.0, 132.3) vs. 85.8 (76.5, 118.0), both P < 0.05], PaO 2/FiO 2 were lower in the HFNC group than that in the HFNC group at 40-48 hours after treatment [mmHg: 223.8 (216.5, 285.0) vs. 278.0 (212.3, 306.0), P < 0.05]. Both HR/SpO 2 and ROX index at 4 hours after treatment had predictive value for 24-hour and 48-hour intubation in the HFNC group. The areas under ROC curve (AUC) of HR/SpO 2 at 4 hours after treatment in the HFNC group were larger than those of ROX index for predicting 24-hour and 48-hour intubation (24-hour: 0.649 vs. 0.574, 48-hour: 0.692 vs. 0.581, both P < 0.01); the 95% confidence interval (95% CI) of 4 hours HR/SpO 2 and for ROX index predicting 24 hours and 48 hours intubation were 0.497-0.780, 0.567-0.799, 0.450-0.694 and 0.454-0.716, respectively. The high sensitivity of HR/SpO 2 and ROX index in predicting 24-hour and 48-hour intubation were 84.6%, 92.9%, 88.2% and 94.4%, respectively, and the low specificity were 52.3%, 23.7%, 54.7% and 29.6%, respectively. Conclusions:HFNC can be used in COPD patients with mild hypercapnia, but it cannot replace NIV. The accuracy of ROX index at 4 hours after HFNC treatment in predicting intubation in COPD patients with mild hypercapnia is poor.
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Objective To investigate the characteristics and failure risk factors of sequential high-flow nasal cannula oxygen therapy (HFNC) after weaning from invasive ventilation. Methods The patients who received sequential HFNC after weaning from invasive ventilation admitted to surgical intensive care unit (ICU) of Peking University People's Hospital from June 1st 2016 to May 31st 2018 were retrospectively analyzed. Clinical variables, respiratory therapy parameters, respiratory variables, cardiac variables and outcomes were reviewed and analyzed. Treatment characteristics of HFNC after weaning was analyzed. Patients were divided into HFNC success group and HFNC failure group according to the failure of HFNC, and the differences between the two groups were compared. The independent risk factors of HFNC treatment failure were analyzed by Logistic regression analysis. The value of predictive treatment failure of risk factors and regression models were analyzed by receiver operating characteristic (ROC) curve. Results A total of 99 patients were included, 61 men, and the median age was 67.0 (57.0, 76.0) years old. The medianinitial HFNC flow was 50 (50, 60) L/min, and inspired oxygen concentration (FiO2) was 0.50 (0.40, 0.60). Eighteen patients experienced HFNC failure (18.2%). Compared with the HFNC success group, the sequential organ failure assessment (SOFA) score in the HFNC failure group was higher [4 (3, 5) vs. 2 (1, 3), P < 0.01], B type natriuretic peptide (BNP) before HFNC therapy were significant higher [ng/L: 647.2 (399.2, 1 331.3) vs. 127.2 (55.2, 369.5), P < 0.01], and respiratory frequency (RR) and heart rate (HR) were significant faster, mean arterial pressure (MAP) was significant higher, oxygen index (PaO2/FiO2) was significant lower after 30 minutes HFNC treatment [RR (times/min): 26 (22, 28) vs. 19 (17, 21), HR (bpm): 105 (97, 107) vs. 85 (77, 90), MAP (mmHg, 1 mmHg = 0.133 kPa): 104.3 (101.7, 110.7) vs. 92.3 (88.3, 97.7), PaO2/FiO2 (mmHg): 207.3 (185.8, 402.8) vs. 320.2 (226.2, 361.5), all P < 0.05]. It was shown by multiple Logistic regression analysis that the SOFA score [odds ratio (OR) = 2.818, P = 0.022, β = 1.036], BNP before HFNC treatment (OR = 1.002, P = 0.033, β = 0.002) and HR after HFNC treatment 30 minutes (OR = 1.140, P = 0.032, β = 0.131) were independent risk factors for HFNC treatment failure. It was shown by ROC curve that the area under the ROC curve (AUC) for the prediction of HFNC failure was 0.840, 0.859, 0.860 and 0.962 for SOFA, BNP before HFNC treatment, HR after HFNC treatment 30 minutes, and regression model, all had good forecast values (all P < 0.01). Conclusions HFNC is one of the commonly used oxygen therapy methods in the ICU, but not all patients who are treated as a sequential therapy after invasive mechanical ventilation weaning can benefit from it. SOFA score, BNP before HFNC treatment and HR after 30 minutes HFNC treatment were independent risk factors of HFNC failure. Each independent risk factor and regression model can predict the success of HFNC treatment.
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Objective To investigate the effect of high-flow nasal cannula oxygen therapy (HFNC) on the clinical efficacy and diaphragm function of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods The patients with mild to moderate AECOPD (clinical classification Ⅰ-Ⅱ) admitted to Huxi Hospital Affiliated to Jining Medical College from January to October in 2018 were enrolled. The patients were divided into HFNC treatment group and routine oxygen therapy control group (each n = 37) by randomly number table method. The two groups were given bronchiectasis drugs, corticosteroids, expectorant, anti-infection treatment, at the same time, the HFNC treatment group was given HFNC with the initial flow rate of 40 L/min. The routine oxygen therapy control group was given low flow oxygen, and the initial flow rate was 3 L/min. General data such as gender, age, clinical grade, acute physiology and chronic health evaluationⅡ (APACHEⅡ) score were recorded. Bedside ultrasound was used to measure the diaphragmatic excursions during quiet breathing (DEq), diaphragmatic excursions during deep breathing (DEd), and diaphragmatic shallow fast breathing index (D-RSBI) before and 2, 24 and 48 hours after treatment in both groups and compared, meanwhile, arterial blood gas analysis was performed, and arterial partial pressure of oxygen (PaO2) and arterial partial pressure of carbon dioxide (PaCO2) were recorded. Results Two patients in the HFNC treatment group withdrew from the study because they could not tolerate HFNC, while other patients were enrolled in the analysis. There was no statistically significant difference in gender, age, proportion of AECOPDⅡ grade or APACHEⅡscore between the two groups, indicating that the general data of the two groups were comparable and balanced. There was no statistically significant difference in DEq, DEd, D-RSBI, PaO2 or PaCO2 before treatment between the two groups. After treatment, DEp in both groups was decreased gradually with time, it was decreased earlier in the HFNC treatment group, and it showed significant difference as compared with that before treatment at 2 hours after treatment (mm: 18.3±3.1 vs. 20.1±4.2, P < 0.01), and it was significantly lower than that in the routine oxygen therapy control group (mm: 18.3±3.1 vs. 20.3±3.7, P < 0.05); DEd was gradually increased in both groups, it was significantly increased in the HFNC treatment group, and it was significantly higher than that in the routine oxygen therapy control group at 24 hours and 48 hours after treatment (mm: 55.2±7.6 vs. 50.8±9.2 at 24 hours, 59.4±7.7 vs. 53.6±9.1 at 48 hours, both P < 0.05); D-RSBI was decreased gradually in both groups, it was decreased earlier and more significant in the HFNC treatment group, and it was significantly lower than that in routine oxygen therapy control group at 24 hours and 48 hours after treatment (times·min-1·mm-1: 0.41±0.13 vs. 0.51±0.20 at 24 hours, 0.31±0.12 vs. 0.43±0.17 at 48 hours, both P < 0.05). After treatment, there was no statistically significant difference in PaO2 or PaCO2 between the two groups. Conclusion HFNC can effectively relieve diaphragm fatigue in patients with mild to moderate AECOPD, but it had no effect on carbon dioxide retention.
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Objective To observe the effect of heated humidified high flow nasal cannula oxygen therapy (HFNC) on patients with post-stroke systemic inflammatory response syndrome (SIRS). Methods Totally 78 patients with post-stroke SIRS were selected in the department of neurology of Wuxi People's Hospital and were randomly divided into HFNC group (n=40) and conventional therapy group (n = 38). The neurological impairment score (NIHSS) , APACHE-Ⅱ, clinical pulmonary infection score (CPIS) , C-reactive protein (CRP) of the 2 groups were recorded before and after the treatment. At the same time, modified Rankin score (mRS) of the two groups were also recorded. Results There was no significant difference in terms of morality and the number of patients with mechanical ventilation in the 2 groups. The 7-day APACHE Ⅱ, 7-day CPIS, 7-day SIRS cure rate, 14-day NIHSS and mRS of 3 months in HFNC group were higher than those in the conventional therapy group (P < 0.05).There was no significant difference in 7-day CRP, 14-day CRP and 14-day CPIS between HFNC group and conventional oxygen therapy group (P> 0.05). Conclusions HFNC can improve lung infection of patients with SIRS thus improve the recovery rate of SIRS. At the same time, it can improve the recovery of the neurological deficit and prognosis in acute stroke.
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Objective To compare the clinical efficacy of high-flow nasal cannula oxygen therapy (HFNC) with non-invasive positive pressure ventilation (NPPV) in patients with traumatic cervical spinal cord injury complicated with acute respiratory failure (ARF).Methods A prospective randomized controlled trial was performed in EICU of the First Affiliated Hospital of Zhengzhou University from May 2016 to January 2018.One hundred sixty-eight consecutive patients with traumatic cervical spinal cord injury complicated with ARF,who did not respond to conventional oxygen therapy,were assigned to the HFNC or NPPV treatment group sequenced by the random number table.The baseline clinical characteristics of randomized participants and respiratory frequency (RR),PaCO2,mean arterial pressure (MAP) at 1,12,24,48 h after treatment were evaluated.Comfortable scale,tracheal intubation rate within 28 d,duration of mechanical ventilation,length of stay in ICU and mortality rate were compared as well.Results There was no significant differences in baseline clinical characteristics,such as sex,age.between the two groups (P＞0.05).RR and PaCO2 were lower in the HFNC group at all time point.In addition,the HFNC group had significantly lower PaCO2 than the NPPV group at 24 and 48 h after treatment (P＜0.01);Oxygenation index (PaO2/FiO2) was improved in both groups,and the HFNC group had superior oxygenation index than the NPPV group at 12,24,48 h after treatment (P＜0.01).Furthermore,the HFNC group had better comfort scale (6.93±0.71 vs 4.29±0.93,P＜0.01),shorter length of stay in ICU and duration of mechanical ventilation compared to the NPPV group (P＜0.01).There was no significant differences in tracheal intubation rate and mortality rate between the two groups (P＞0.05).Conclusions In addition to the superior efficacy in improving respiratory function and shortening length of stay in ICU,HFNC was well tolerated by patients with traumatic cervical spinal cord injury complicated with ARF,and could be recommended in clinical practice.
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Objective To compare the efficacy of high flow nasal cannula oxygen therapy (HFNC) and non-invasive ventilation (NIV) in the treatment of chronic obstructive pulmonary disease (COPD) with acute-moderate type Ⅱ respiratory failure,and to explore the feasibility of HFNC in the treatment of COPD with respiratory failure.Methods Patients diagnosed with COPD with acute moderate type Ⅱ respiratory failure (Arterial blood gas pH 7.25-7.35,PaCO2＞ 50 mmHg) admitted to the ICUs from April 2017 to December 2017 were retrospectively analyzed.All patients who were treated with HFNC within the first 4 hours after the admission to the ICUs,and continued for more than 2 hours and for at least 4 hours within the first 24 hours were included in the HFNC group.Those treated with NIV in the same conditions were included in the NIV group.The end point was the failure rates of treatment (changing to respiratory support method in another group or invasive ventilation) and 28-day mortality.Results Eighty-two patients (39 in the HFNC group and 43 in the NIV group) were enrolled.The HFNC group had a treatment failure rate of 28.2％,which was lower than that of the NIV group (39.5％).However,Kaplan-Meier curve analysis showed no significant difference between the two groups (Log Rank test 1.228,P=0.268).The 28-day mortality rate in HFNC group was 15.4％,which was no different from 14％ in NIV group (Log Rank test 0.049,P=0.824).The number of airway care interventions within the first 24 hours was significantly lower in the HFNC group than in the NIV group [5 (3～8) vs.11 (7～15)],whereas the duration of respiratory support within the first 24 hours was significantly longer in the HFNC group than in the NIV group [16 (9～22) hours vs.8 (4～11) hours] (all P＜0.05).The incidence of nasal facial lesions in the NIV group was 20.9％,significantly higher than that of HFNC group (5.1％,P ＜0.05).Conclusion For COPD with acute moderate type Ⅱ respiratory failure,HFNC has similar therapeutic effects as NIV.HFNC has better therapeutic tolerance and is a new potential respiratory support method for clinical treatment of COPD with respiratory failure.
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INTRODUCTION: High-flow nasal cannula is an oxygenation therapy in patients with acute respiratory failure. There are, some questions about this technique which answer is needed. MATERIAL AND METHODS: We analyzed all patients that require high-flow nasal cannula oxygen therapy admitted to a polyvalent intensive care unit of a university tertiary hospital. We select those patients who require the therapy as initial support for their acute respiratory failure. We analyzed the mortality and connection to mechanical ventilation (V.M.) rate. We performed a global analysis and then a sub analysis for underlying pathology. Our objective is to describe which pathology has the best results with this treatment. Patients who require therapy to support scheduled extubation, heart failure, pulmonary thromboembolism, thoracic trauma and decreased level of consciousness were excluded. RESULTS: We analysed a total of 128 patients. 76 Men, Mean age 57.4 years, APACHE II 19; SOFA 8.2; SAPS II 55.2; Mean income 13.3 days; Patients required the therapy an average of 2.8 days. 65 patients required connection to M.V. after HFNC therapy. Those patients who were intubated in the first 48 hours had a mortality rate of 45% while those in which the therapy was delayed more than 48 hours had a mortality rate of 56% (P = 0.3). Patients were divided according to their underline pathology. Acute respiratory failure: Extra pulmonary or intra pulmonary (Pneumonia in immunosuppressed and Pneumonia in immuno competent). In the first group, connection to MV was required in 54% of the cases, with a mortality rate of 54% in those intubated in the first 48 hours vs 40% later. In the group of pneumonia in immunosuppressed patients, M.V. was required in the 60.5% of the cases with a mortality rate of 75% in those intubated in the first 48 hours vs 71% posteriorly. In the group Pneumonia in immuno competent, M.V. was required in 42% of the cases with a mortality rate of 10% in the ones intubated the first 48 hours vs 50% later. Statistically significant differences were observed regarding the need of M.V connection according to base pathology. CONCLUSIONS: Results of HFNC oxygen therapy do not appear to be different in pulmonary or extrapulmonary respiratory failure. The severity of the patient ilness is related to the need of mechanical ventilation and mortality rate. The patient who benefits the most from the early identification of the failure of this therapy, is the one who presents acute respiratory failure due to pneumonia in immunocompetent patient.
INTRODUCCIÓN: La oxigenoterapia de alto flujo es una técnica de oxigenación en los pacientes con insuficiencia respiratoria aguda. Existen, algunas preguntas acerca de esta técnica que necesitan respuesta. MATERIAL Y MÉTODOS: Analizamos todos los pacientes que requieren oxigenoterapia de alto flujo ingresados en una Unidad de Cuidados Intensivos polivalente de un hospital terciario universitario. Seleccionamos aquellos pacientes que requieren la terapia como soporte inicial de su insuficiencia respiratoria aguda. Analizamos la mortalidad y conexión a ventilación mecánica (V.M.). Realizamos un análisis global y posteriormente un subanálisis por patología subyacente. Nuestro objetivo es describir en que patología presenta mejores resultados. Se excluyen los pacientes que requieren la terapia como apoyo a la extubación programada, insuficiencia cardiaca, tromboembolismo pulmonar, trauma torácico y disminución del nivel de conciencia. RESULTADOS: Analizamos un total de 128 pacientes. Setenta y seis varones, edad media 57,4 años, APACHE II 19; SOFA 8,2; SAPS II 55,2; días de ingreso medio 13,3; Los pacientes requieren la terapia una media de 2,8 días. Sesenta y cinco pacientes requieren conexión a V.M. tras uso de esta terapia. Aquellos pacientes que son intubados en las primeras 48 horas presentan una mortalidad de 45%, mientras que aquellos en los que la terapia se alarga más de 48 horas la mortalidad es del 56% (p = 0,3). Se divide a los pacientes según su patología de base. Insuficiencia respiratoria de causa: Extrapulmonar, neumonía en inmunodeprimido y neumonía en inmuno competente. En el primer grupo se objetiva conexión a V.M en un 54% de los casos, con una mortalidad del 54% en aquellos intubados en las primeras 48 horas vs 40% posteriormente. En el grupo neumonía en inmunodeprimido se requiere V.M en el 60,5% con una mortalidad del 75% en aquellos intubados en las primeras 48 horas vs 71% posteriormente. En el grupo neumonía en inmunocompetente objetivamos conexión a V.M. en el 42% con una mortalidad del 10% en los intubados las primeras 48 horas vs 50% posteriormente. Se objetivan diferencias estadísticamente significativas respecto a necesidad de conexión a V.M. según patología de base. CONCLUSIONES: Los resultados de la terapia de alto flujo no parece ser diferente en la insuficiencia respiratoria de causa pulmonar o extrapulmonar. La gravedad del enfermo se relaciona con la necesidad de ventilación mecánica y mortalidad. El paciente que más se beneficia de la rápida identificación del fracaso de esta terapia es el que presenta insuficiencia respiratoria por neumonía en paciente inmunocompetente.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Oxygen Inhalation Therapy/methods , Respiratory Insufficiency/therapy , Pneumonia/therapy , Respiration, Artificial/adverse effects , Severity of Illness Index , Acute Disease , Retrospective Studies , Immunocompromised Host , Cannula , Immunocompetence , Intensive Care UnitsABSTRACT
Objective To explore the clinical value of humidified high flow nasal cannula oxygen therapy (HHFNC) oxygen therapy for acute hypoxic respiratory failure.Methods Totally 37 patients with acute hypoxic respiratory failure were enrolled who entered ICU from January 2016 to June 2016 and randomly divided into FM group (n=l8) and HHFNC group (n=19).The values of blood gas analysis were recorded as before treatment,1 h and 5 h after therapy,respectively.Results 1 h and 5 h after therapy,both groups had significant increase in pa(O2) compared to before treatment (P＜0.05).Meanwhile,HHFNC group had higher level ofpa(O2) in comparison to FM group (P＜0.05).Conclusion HHFNC oxygen therapy has a therapeutic effect on acute hypoxic respiratory failure which helps to correct hypoxemia and improve subject feeling of comfort.
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Acute respiratory failure (ARF) is one primary cause of intensive care unit (ICU) admittance, which is usually treated with intubation and mechanical ventilation in order to maintain a necessary ventilation and oxygenation function. After the remove of trachea tube, available oxygenation supports include nasal cannula, venturi mask, non-invasive ventilator and high flow nasal cannula (HFNC). In this articlewe reviewed the physiological mechanism related to HFNC therapy and trails about the application of HFNC in extubated patients. HFNC can provide well heated and humidified high flow gas with a high concentration of oxygen, which can improve the oxygenation and degree of comfort of patients after extubation. Furthermore, HFNC can improve the prognosis of these patients. However, HFNC has little influence on non-ventilation related factor and severe dysfunction of ventilation, so its indication and risk factor of treatment failure should be further evaluated with randomize controlled trials.
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Objective To assess the efficacy,comfort and tolerability of high-flow nasal cannula oxygen therapy in patients with acute respiratory failure (ARF).Methods The literature of RCTs concerning high-flow nasal cannula (HFNC) versus usual oxygen care (UOC) in ARF patients was searched using the national and international electronic databases.All relevant studies were screened according to inclusion and exclusion criteria,and then the included studies were evaluated,and finally,the extracted data were analyzed using Rev Man 5.3 software provided by the Cochrane Collaboration.Results eleven RCTs were included in 3 170 patients,of those 1 550 patients were in HFNC group,while 1 620 patients were in UOC group.There was no statistical difference in mortality among in HFNC and UOC group (OR =0.92,95％ CI:0.70-1.2,P =0.53),neither was the incidence of nosocomial infection (OR =0.85,95％ CI:0.63-1.15,P =0.3).The incidence of endotracheal intubation was lower in HFNC group than in UOC group.The comfort and tolerablity was greater in HFNC group than that in UOC group.Conclusions No difference in mortality or nosocomial infection was detected in patients with ARF treated with HFNC compared with UOC.However,HFNC seem well tolerated by patients and showed a lower rate of endotracheal intubation.
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Objective To evaluate the feasibility and effect of sequential treatment by the heated humidified high flow nasal cannula oxygen therapy (HFNC) in mechanically ventilated patients following endotracheal tube extubation.Methods A prospective randomized controlled trial was conducted. Forty-nine patients with the sequential treatment after tracheal intubation extraction admitted to Department of Critical Care Medicine of Shanghai Tenth People's Hospital from January 1st to December 31st 2016 were enrolled. The patients were randomly divided into HFNC group (n = 25) and non-invasive positive pressure ventilation (NPPV) group (n = 24) in accordance with the random numbertable. During the study, arterial blood gas and the sputum viscosity were assessed at 12, 24, and 48 hours after NPPV or HFNC treatment, and the nasal and facial pressure ulcers within 1 week was also recorded. Receiver operating characteristic curve (ROC) was plotted, and the effect of NPPV or HFNC on oxygenation was analyzed.Results Among the 25 patients in the HFNC group, 1 patient who was re-intubated and 2 patients who were changed to NPPV were excluded, and a total of 22 patients with complete data were enrolled in HFNC group. Among the 24 patients in the NPPV group, 1 patient who gave up the treatment and 1 patient who was re-intubated were excluded, and a total of 22 patients with complete data were enrolled in NPPV group. After the sequential treatment, most patients in NPPV group showed moderate viscous sputum (12, 12 and 10 cases at 12, 24 and 48 hours, respectively), whereas the patients in HFNC group showed thin sputum (15, 16 and 15 cases at 12, 24 and 48 hours, respectively). Sputum viscosity of patients in HFNC group at each time point was significantly lower than that in NPPV group (allP < 0.01). Arterial oxygen saturation (SaO2) and arterial partial pressure of oxygen (PaO2) at 12, 24 and 48 hours in the HFNC group were significantly higher than those in the NPPV group [SaO2: 0.978±0.009 vs. 0.906±0.139 at 12 hours, 0.976±0.019 vs. 0.924±0.103 at 24 hours, 0.973±0.019 vs. 0.935±0.079 at 48 hours; PaO2 (mmHg, 1 mmHg = 0.133 kPa): 97.85±22.99 vs. 79.24±25.86 at 12 hours, 108.10±43.87 vs. 84.44±29.24 at 24 hours, 102.31±39.02 vs. 79.04±27.46 at 48 hours, allP < 0.05], however, the difference in arterial partial pressure of carbon dioxide (PaCO2) at all of the time points between the two groups was not significant. In NPPV group, 4 patients with nasal and facial pressure ulcers was found, and all with Ⅰ phase of pressure ulcers, and no nasal and facial pressure ulcers was found in HFNC group, which was significantly decreased as compared with NPPV group (χ2 = 4.400,P = 0.036). A good effect of oxygen therapy was defined as PaO2 at 48 hours after the sequential treatment was increased by 20% as compared with that before the treatment. ROC curve analysis showed that the area under the ROC curve (AUC) of HFNC on improving oxygenation was higher than that of NPPV (0.917 vs. 0.830); when PaO2 at 48 hours after HFNC treatment was 76.25 mmHg, the sensitivity was 100%, and the specificity was 75.0%.Conclusions Compared with NPPV, adoption of HFNC as sequential treatment is a feasible manner in dealing with the mechanically ventilated patients after endotracheal tube extubation, which can improve the oxygenation as well as reducing the degree of sputum viscosity and incidence of nasal and facial pressure ulcers. HFNC is a promising therapy, which may be worthy to recommend broadly in such a clinical situation.
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Objective To evaluate the clinical effects of heated humidified high flow nasal cannula oxygen therapy on post-extubation intensive care unit(ICU)patients. Methods A computerized search was performed through Cochrane Library,EMBASE,PubMed,Elsevier,CNKI,Wanfang Database, SinoMed for randomized controlled trial(RCTs) which studied the effects of clinical effects of heated humidified high flow nasal cannula oxygen therapy on post-extubation ICU patients. Two reviewers separately searched the articles, evaluated the quality of the literatures, extracted date according to the inclusion and exclusion criteria. RevMan5.3 was used for Meta-analysis. Results Five RCTs were included involving 982 patients in the study. The Results of meta-analysis showed that the HFNC group was lower than COT group on the re-intubation rate (OR=0.39, 95% CI 0.25-0.62, P<0.05). About oxygenation index, comfort level and toleration of patients, HFNC group was superior to the COT group. Two groups had no significant differences(P>0.05)on post-extubation respiratory failure(OR=0.85,95% CI 0.35-2.09),respiratory infection(OR=0.69,95% CI 0.36-1.34),hospital length of stay(MD=0.51,95%CI-0.02-1.03), mortality of hospital (OR=0.81,95% CI 0.39-1.69). Conclusions The use of HFNC oxygen therapy can reduce there-intubation rate,improve oxygenation index,comfort level and tolerance on post-extubation ICU patients, while HFNC group has no significant impact on the post-extubation respiratory failure, respiratory infection, hospital length of stay, mortality of hospital compared with COTgroup. However, in view of the quantity and quality of study. More RCTs should be conducted to verify the results.
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Objective To explore the clinical value of humidified high flow nasal cannula oxygen therapy (HHFNC) oxygen therapy for acute hypoxic respiratory failure.Methods Totally 37 patients with acute hypoxic respiratory failure were enrolled who entered ICU from January 2016 to June 2016 and randomly divided into FM group (n=l8) and HHFNC group (n=19).The values of blood gas analysis were recorded as before treatment,1 h and 5 h after therapy,respectively.Results 1 h and 5 h after therapy,both groups had significant increase in pa(O2) compared to before treatment (P＜0.05).Meanwhile,HHFNC group had higher level ofpa(O2) in comparison to FM group (P＜0.05).Conclusion HHFNC oxygen therapy has a therapeutic effect on acute hypoxic respiratory failure which helps to correct hypoxemia and improve subject feeling of comfort.
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Actively heated, humidified high flow nasal cannula oxygen therapy (HFNC) is a new type of oxygen therapy. Because of its unique physiological effects, the clinical application is becoming more and more popular. This article is to summarize the physiological effects, clinical application and short comings of HFNC. Compared with conventional oxygen therapy, HFNC helps to improve oxygenation better, and it is more comfortable than non-invasive ventilation (NIV) in use. Proper use of HFNC may be able to reduce the use of NIV and decrease the rate of endotracheal intubation. It can be used for adults with mild to moderate hypoxia, or for patients undergoing palliative care. However, the experience of the use of HFNC in adults is limited, and there is yet no corresponding clinical guideline. Therefore, further research with a large sample is required to determine the long-term effect of this technique, and to identify the adult patient population to whom is most beneficial.
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High flow nasal cannulae(HFNC),a new mode of noninvasive respiratory support,by high-flow nasal cannula transports humidified,warmed and high flow maxed oxygen above the flow of 1 ~2 L/min. In the application of Neonatology,the higher oxygen flow and the smaller body type of newborn cause the stron-ger the expansion pressure by HFNC,and following the change of the amount of oxygen leaking along the con-duit.The effect of HFNC in improving respiratory parameters (such as neonatal tidal volume and respiratory function)was similar to nasal continuous positive airway pressure(NCPAP),but the effectiveness is limited to the flow less than 2L/min.A growing number of evidence suggests that HFNC as an alternative method for pre-term non-invasive alternative ventilation is available,but the effect and safety of applications in preterm still need further research.HFNC is not recommended popularized in preterm until more randomized trials to confirm.