Value of high-flow oxygen therapy after weaning for successful extubation of critical ill patients with mechanical ventilation / 中华危重病急救医学

ABSTRACT

Objective:To investigate the value of high-flow oxygen therapy after weaning in successful extubation of critically ill patients with mechanical ventilation.Methods:A retrospective study was conducted. The weaned patients who were older than 18 years old and underwent mechanical ventilation for the first time due to cerebrovascular accidents, surgical operations, cardiovascular diseases, and pneumonia admitted to the department of critical care medicine of Zhejiang Hospital from January 2018 to June 2020 were enrolled. Among the patients, 40 cases received high-flow oxygen therapy after weaning, and 37 cases received Venturi combined with the humidifier. The patient's gender, age, primary disease, severity score, duration of mechanical ventilation before weaning, heart rate (HR), blood pressure, pulse oxygen saturation (SpO 2) at 0, 6, 12, 18, and 24 hours after weaning, and pH value, arterial partial pressure of oxygen (PaO 2), arterial partial pressure of carbon dioxide (PaCO 2) at 6, 12, 18, and 24 hours after weaning, the rate of performing mechanical ventilation after weaning, extubation time after weaning, and the rate of reintubation after extubation for 72 hours were collected. Results:There was no significant difference in baseline data such as gender, age, primary disease, severity score, and duration of mechanical ventilation before weaning between the two groups. After weaning, the vital signs of the two groups were stable, and there was no significant difference in HR, systolic blood pressure (SBP), diastolic blood pressure (DBP) or SpO 2 at each time point between the two groups. After weaning, the pH of arterial blood gas analysis in the two groups and the fluctuations of PaO 2 and PaCO 2 in the high-flow group were not obvious. In the Venturi group, PaO 2 gradually decreased after weaning, PaCO 2 increased significantly at 12 hours, and slowly decreased after 12 hours. The PaO 2 from 6 hours and PaCO 2 from 12 hours in the high-flow group were significantly lower than those in the Venturi group, and continued to 24 hours [PaO 2 (mmHg, 1 mmHg≈0.133 kPa): 112.34±38.25 vs. 156.76±68.44 at 6 hours, 110.92±38.66 vs. 150.64±59.07 at 12 hours, 111.12±36.77 vs. 141.30±39.05 at 18 hours, 110.82±39.37 vs. 139.65±41.50 at 24 hours; PaCO 2 (mmHg): 41.30±7.51 vs. 47.42±7.54 at 12 hours, 40.97±6.98 vs. 45.83±8.63 at 18 hours, 40.10±7.06 vs. 46.14±9.15 at 24 hours, all P < 0.01]. The rate of performed mechanical ventilation after weaning and the rate of reintubation after extubation for 72 hours in the high-flow group were significantly lower than those in the Venturi group [17.5% (7/40) vs. 40.5% (15/37), 6.2% (2/32) vs. 31.8% (7/22), both P < 0.05], and the extubation time after weaning was significantly shorter than that in the Venturi group (hours: 22.43±11.72 vs. 28.07±10.42, P < 0.05). Conclusion:Using high-flow oxygen therapy to the extubation process of critically ill mechanical ventilation patients can reduce the incidence of carbon dioxide retention and the rate of performed mechanical ventilation after weaning, shorten the extubation time after weaning, and reduce the rate of reintubation after extubation for 72 hours.