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Objective:To explore whether the adoption of high-flow nasal cannula (HFNC) as an initial oxygen therapy in emergency department (ED) could reduce the intubation rate and improve the clinical outcomes of patients with dyspnea and hypoxemia compared with conventional oxygen therapy (COT).Methods:A perspective single-center randomized controlled trial was conducted in the First Affiliated Hospital of Zhengzhou University from October 1, 2019 to September 30, 2020. A total of 210 eligible patients with acute dyspnea and hypoxemia in ED were recruited and randomized (in 1:1) to receive HFNC or COT for 1 h immediately after the grouping. The primary outcome was the rate of intubation within 24 h. The secondary outcomes included total intubation rate, escalation of breathing support method, patients’ disposition, length of ICU stay and hospital mortality. Continuous outcomes were analyzed by independent samples t test or Mann-Whitney U test according to the data distribution. Discontinuous outcomes were compared with the Chi-square test. Kaplan-Meier curve analysis was performed for 60-day survival. Results:Finally, 105 patients were recruited in each group. HFNC reduced the intubation rate within the first 24 h (4.8% vs. 14.3%, P = 0.019) and the rate of patients escalated to upgrade oxygen therapy (34.3% vs. 53.3%, P = 0.005), but did not affect the total intubation rate during the whole attendance ( P = 0.509). In ED, HFNC helped more patients to achieve the targeted saturation of pulse oxygen (90.5% vs. 78.1%, P = 0.02), and reduced respiratory rate (RR) to < 25 breaths per min (68.6% vs. 49.0%, P = 0.004), but did not affect the length of hospital stay, hospital mortality and 60-day survival rate ( P > 0.05). Conclusions:Initial application of HFNC in ED could reduce the intubation rate within 24 h, decrease the rate of escalation of oxygen therapy, improve oxygenation and relieve dyspnea.
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Objective? To?compare?the?efficacy?and?safety?of?conservative?and?conventional?oxygen?therapy?in?critically?ill?patients.? Methods? Relevant?literature?and?randomized?controlled?trials?(RCTs)?about?the?effect?of?conservative?oxygen?therapy?and?conventional?oxygen?therapy?on?the?prognosis?of?intensive?care?unit?(ICU)?critically?ill?patients?was?searched?from?CNKI,?VIP,?Wanfang?Data,?Chinese?Clinical?Trial?Registry,?PubMed,?Embase,?the?Cochrane?Library,?and?ClinicalTrials.gov?by?using?the?keywords?"critically?ill?patients,?conservative?oxygen?therapy,?liberal?oxygen?therapy,?conventional?oxygen?therapy,?mortality"?until?October?30th?in?2018.?The?main?outcome?indicators?were?short-term?mortality?(28-day?mortality?or?ICU?mortality);?secondary?indicators?were?90-day?mortality,?duration?of?mechanical?ventilation,?the?length?of?ICU?stay,?total?hospitalization?time,?new?infection?rate?in?ICU?and?incidence?of?new?organ?dysfunction?in?ICU.?In?the?conservative?oxygen?therapy?group,?the?aim?of?pulse?oxygen?saturation?(SpO2)?was?0.90-0.92?or?the?arterial?partial?oxygen?pressure?(PaO2)?was?70-100?mmHg?(1?mmHg?=?0.133?kPa),?while?in?conventional?oxygen?therapy?group?SpO2?>?0.96?or?PaO2?>?150?mmHg.?Literature?search,?quality?evaluation?and?data?extraction?was?conducted?independently?by?the?two?authors.?The?quality?of?these?study?was?evaluated?using?Cochrane?risk?deviation?assessment?tool,?and?the?relevant?data?were?analyzed?using?RevMan?5.3?software.? Results? Four?studies?were?included?in?the?analysis,?these?studies?were?assessed?as?moderate?to?high?quality?studies.?A?total?of?1?076?patients?were?enrolled,?with?539?in??the?conservative?oxygen?therapy?group?and?537?in?the?conventional?oxygen?therapy?group.?Compared?with?conventional? oxygen?therapy?group,?short-term?mortality?[odds?ratio?(OR)?=?0.66,?95%?confidence?interval?(95%CI)?=?0.50-0.87,?P?=?0.003]?and?the?incidence?of?new?organ?dysfunction?in?ICU?(OR?=?0.64,?95%CI?=?0.41-0.99,?P?=?0.04)?were?significantly?decreased?in?conservative?oxygen?therapy?group,?duration?of?mechanical?ventilation?was?significantly?prolonged?[standardized?mean?difference?(SMD)?=?17.17,?95%CI?=?7.14-27.21, P?=?0.000?8].?But?there?was?no?significantly?difference?in?90-day?mortality?(OR?=?0.83,?95%CI?=?0.59-1.17,?P?=?0.28),?new?infection?rate?in?ICU?(OR?=?0.90,??95%CI?=?0.66-1.21,?P?=?0.47),?the?length?of?ICU?stay?(SMD?=?-0.22,?95%CI?=?-1.02-0.59,?P?=?0.60)?and?total?hospitalization?time?(SMD?=?1.44,?95%CI?=?-1.43-4.31,?P?=?0.32)?between?the?two?groups.? Conclusion? Compared?with?conventional?oxygen?therapy,?conservative?oxygen?therapy?can?reduce?short-term?mortality?and?the?incidence?of?organ?dysfunction?in?critically?ill?patients,?but?cannot?decrease?the?length?of?ICU?stay?and?total?hospitalization?time.
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Objective To systematically evaluate the effect of high-flow nasal cannula oxygen (HFNC) on improving the atelectasis and respiratory function in adults after cardiac surgeries.Methods All randomized controlled trials (RCTs) about HFNC therapy for adults after cardiac surgeries published from January 2000 to March 2018 were searched through CNKI, CBM, VIP, Wanfang, PubMed, Springer Link, Embase, Web of Science, Cochrane Library. The references from relevant articles were searched. The experimental group was treated with HFNC while the control group treated with conventional oxygen therapy (COT). The outcome measurements included radiological atelectasis score (RAS), endotracheal reintubation rate and the length of intensive care unit (ICU) stay. Two researchers were responsible for literature screening, data extraction and quality evaluation respectively. Meta-analysis was performed with RevMan 5.2 software. Funnel plot was used to analyze the publication bias.Results A total of 4 RCTs were enrolled and 643 patients were included (325 in experimental group and 318 in control group). Meta-analysis showed that the tracheal reintubation rate in experimental group was lower than that in control group [odds ratio (OR) = 0.26, 95％ confidence interval (95％CI) = 0.09-0.74,P = 0.01], but there was no significant difference in RAS [mean difference (MD) = -0.15, 95％CI = -0.50-0.21,P = 0.41] and the length of ICU stay (MD= 0.09, 95％CI =-0.09-0.26,P = 0.33) between experimental group and control group. Sensitivity analysis was performed in two trials with low risk of bias, which demonstrated that there was no significant difference in RAS between the two groups (MD =0.06, 95％CI = -0.26-0.37,P = 0.73). It was shown by the funnel analysis that there was bias in the study of the length of ICU stay in the literature, while the bias of RAS and tracheal reintubation rate was low.Conclusion Compared with COT, HFNC could reduce the rate of tracheal reintubation in adults after cardiac surgeries, but no difference was found in improving atelectasis or reducing the length of ICU stay.
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Objective To study the effect of high-flow oxygen insuffiation (HFOI) via nasal cannula in reduction in re-intubation rate,length of ICU stay and improvement of respiratory function in patients at high risk of re-intubation after weaning from mechanical ventilation assessed by lung ultrasound score (LUS).Methods Single center randomized(random number) clinical trial was carried out in one intensive care units in China from May 2016 to May 2017 including critically ill patients ready for planned extubation with high-risk factors for re-intubation assessed by LUS when the LUS ≥ 14 was considered to be high risk.The comparisons of the length of ICU stay,re-intubation rate in case of respiratory failure,respiratory rate pulse rate SaO2 PaO2/FiO2 of patients at 6 h,24 h and 48 hours after extubation were made between HFOI and conventional oxygen therapy (COT) group.Results During the study period,32 patients were enrolled in the study.Of them,15 were assigned in HFOI group and 17 in COT group.The length of ICU stay (8.0±2.4)days vs.(10.9±3.5) days and re-intubation rate (6.7％ vs.23.5％) were significantly different between two groups (P＜0.05).The respiratory rate pulse rate SaO2 and PaO2/FiO2 of patients at 6 h after ex-tubation in HFOI group were improved than those in COT group (P＜0.05);and the SaO2 and PaO2/FiO2 of patients 24 h and 48 h after ex-tubation in HFOI group had much more improvement than those in COT group (P＜0.05).Conclusion Among high-risk adults who assessed by lung ultrasound score,high-flow oxygen therapy could reduce re-intubation rate length of ICU stay and improve the respiratory function.High-flow oxygen therapy may offer advantages for these patients.