The use of high-flow nasal cannula oxygenation in adult patients with acute lung injury after liver transplantation / 中华肝胆外科杂志

ABSTRACT

Objective To study the use of high flow nasal cannula oxygenation (HFNCO) on the respiratory function of patients with acute lung injury after liver transplantation.Methods This is a randomized controlled interventional study.Among 200 adults who underwent liver transplantation from Jan 2015 to Dec 2015 in the Department of Transplant Surgery,Tianjin First Central Hospital,80 patients who did not meet the criteria for acute lung injury were excluded.Of the remaining 120 patients who were included in the study,they were divided into the HFNCO group and the nasal catheter group by the random number table method,with 60 patients in each group.The respiratory rate (RR),oxygenation index (PaO2/FiO2) and PaCO2 were recorded immediately after extubation,2 h after extubation,1 st day after extubation and 2nd day after extubation.The reintubation rate and duration of ICU stay were compared.Results The incidence of acute lung injury after liver transplantation was 60.0％ (120/200).There was no reintubation in the HFNCO group,and 6 patients (10.0％) in the nasal catheter group were reintubated.The difference between the two groups was statistically significant (P ＜ 0.05).The RR of the HFNCO group was lower than that of the nasal catheter group [(19.4 ± 4.5) breaths/min vs.(21.7 ± 5.1) breaths/min],[(18.9 ± 4.2) breaths/min vs.(22.5 ± 4.4) breaths/min],[(19.0 ± 3.7) breaths/min vs.(23.2 ± 4.7) breaths/min] (all P ＜0.05) 2 h after extubation,on the 1st and 2nd day after extubation.The oxygenation index of the HFNCO group was significantly higher than that of the nasal catheter group [(242.6 ± 65.0) mmHg vs.(206.6 ±44.2)mmHg],[(245.6±70.4)mmHg vs.(211.1 ±62.8)mmHg],[(238.2±62.8)mmHg vs.(210.4±57.1)mmHg] (all P ＜0.05).There was no statistically difference in the PaCO2 and the duration of ICU stay between the two groups (P ＞ 0.05).Conclusions Compared with the conventional nasal catheter oxygen inhalation,HFNCO was more effective in improving oxygenation index,reducing RR,improving respiratory function and reducing reintubation rate in patients with acute lung injury after liver transplantation.HFNCO is a more suitable oxygen therapy for patients with acute lung injury after liver transplantation.