Effects Of High-Flow Nasal Cannula On The Patients With AECOPD Receiving Invasive-noninvasive Sequential Ventilation Therapy

ObjectiveThis study selected NIPPV?non-invasive positive pressure ventilation NIPPV?as the control group to explore the effectiveness and safety of HFNC in sequential mechanical ventilation in patients with AECOPD,in order to provide data support for whether HFNC can replace NIPPV in sequential ventilation in patients with AECOPD.MethodPatients with COPD who were intubated for exacerbation in the comprehensive ICU of the affiliated hospital of Qingdao university were selected as research objects from December 2015 to July 2018.And 81 patients who finally met the inclusion criteria were divided into group HFNC?40?and group NIPPV?41?by random number table method.The Mindray EV300 with high flow rate and humidifier system was adopted in group HFNC,and the size of nasal cannulas was chosen according to the size of the patient's nostrils?less than50%of the nostrils'diameter?.The Philips V60 noninvasive ventilator was used in group NIPPV.And the parameters of both group were adjusted within setting range according to the results of patients'arterial blood gas,tolerance and clinical manifestations.On the basis of routine care and treatment,respiratory indexes?RR,PCO₂,PaO₂/FiO₂?and cycle indicators?HR,MAP?at 2h,12h,24h and 48h after oxygen therapy,as well as the incidence of complication?facial skin break down,abdominal distension,aspiration,delirium?,patient comfort score,number of patients who needed bronchoscopy for secretion removal within 48 hr after extubation,re-intubation rate,mortality within 28 days and length of stay in ICU were recorded,inter-group and intra-group comparisons were performed for this two groups;Visual analogue scale?VAS?was used to assess patients'comfort.Data analysis was conducted with SPSS 22.0.Results?1?The baseline data of both groups such as age,gender,smoking history,the history of COPD,BMI,APACHE II,PaCO₂ before extubation in two groups,PaO₂/FiO₂,RR,HR and MAP were not statistically significant?P>0.05?.?2?There was no significant difference between baseline RR and RR at 2h,12h,24h and 48h after treatment in two groups?P>0.05?.There was no significant difference in RR between the two groups at the same time point?P>0.05?.?3?There was no statistically significant difference between PaO₂/FiO₂ of pre-exubation and PaO₂/FiO₂ at 2h in two groups?P>0.05?,PaO₂/FiO₂ at 12h,24h and 48h of both groups were significantly higher than pre-exubation?P<0.05?;for the comparison of PaO₂/FiO₂ between groups at the same time point,there was no significant difference?P>0.05?.?4?PaCO₂ at 12h,24h and 48h was found to be significantly lower than pre-exubation in both groups?P<0.05?,there was no statistically significant difference between PaCO₂ of pre-exubation and PaCO2 at 2h in the two groups?P>0.05?;there was no significant difference in PaCO2 between the two groups at the same time point?P>0.05?.?5?For in-group comparisons on HR and MAP at different time points,there was no significant difference in two groups?P>0.05?;no significant differences were observed in HR and MAP between groups at the same time point?P>0.05?.?6?There was no significant difference in the incidence of complications such as delirium,aspiration and facial skin break down between two groups?P>0.05?;The incidence of abdominal distension in group HFNC was significantly lower than group NIPPV?P<0.05?.?7?No significant differences were observed in the re-intubation rate,mortality within28 days,as well as length of ICU stay?P>0.05?.?8?The comfort scores in the group HFNC were better than group NIPPV?P<0.01?;and fewer patients in the group HFNC needed bronchoscopy for secretion management or sputum suction through oral and nasal within 48 hr after extubation?P<0.05?.ConclusionHFNC had the similar effect as NIPPV in reducing PaCO₂,improving PaO₂/FiO₂,but HFNC was better than NIPPV in patients'comfort,tolerance and airway management.Therefore,HFNC may replace NIPPV as an invasive-noninvasive sequential oxygen therapy for the patients with AECOPD.