| Objective Optimal oxygen supply is the cornerstone of the management of critically ill patients after extubation,especially in patients at high risk for extubation failure.In recent years,high flow oxygen system devices have offered an appropriate alternative to standard oxygen therapy devices such as conventional face masks and nasal prongs.This research explored the efficacy of Humidified High Flow nasal cannula(HFNC)in Intensive Care Unit(ICU)adult patients after extubation.In purpose to improve the level of oxygen therapy of adult ICU patients after extubation.Methods We retrospectively analyzed 126 cases of consecutive ventilated critical care adult patients aged above 18 years old in the ICU of ours hospital during January 2014 to December 2016 who were treated with oral tracheal intubation ventilator assisted ventilation,comply with the set of conditions(ventilated critical care patients in ICU who needed further oxygen therapy after extubation),This patients include 43 cases of severe pneumonia(28 cases of HFNC group,15 cases of NRB group),30 cases of chest trauma(17 cases of group HFNC,13 cases of group NRB),22 cases of cerebral infarction(15 cases of group HFNC,7 cases of group NRB),3 cases of obesity(2 cases of HFNC group,,1 cases of NRB group),15 cases of acute pancreatitis(10 cases of group HFNC,5 cases of group NRB),8 cases of cerebral hemorrhage(4 cases in each group),pulmonary embolism(3 cases of HFNC group,2 cases of NRB group).Those patients with tracheal fistula?COPD?obstructive sleep apnea and history of asthma were ruled out.The 126 patients were allocated to two groups: HFNC group and NRB group.The former contain 79 cases in total,while the latter have 47 cases in its group.Vital respiratory(level of Pa O2/Fi O2 and Pa CO2)and physiological parameters(respiratory rate,heart rate,mean arterial pressure)were assessed prior to extubation and 1 hours after extubation.The primary clinical outcomes measured were improvement in oxygenation and re-intubation.Results Patients of this two groups ranged from 18 to 78 years old,with an average age of 54.28 ±14.99 years old,including 67 cases of male(41 cases of HFNC group,26 cases of NRB group),59 cases of female(38 cases of HFNC group,21 cases of NRB group).There were no significant differences in age and sex between this two groups(P>0.05).The average score APACHE II of this two groups was 22.10±4.33,and the average time of mechanical ventilation before extubation in ICU was 6.56±2.53 days,there were also no statistically significant differences in the APACHE II score and mechanical ventilation time between the two groups(P>0.05).The two groups demonstrated similar hemodynamic patterns before and after extubation.The respiratory rate was slightly elevated in both groups after extubation with no differences observed between groups(P>0.05).There were no statistically significant clinical differences between two groups in Pa O2/Fi O2 and Pa CO2 level before extubation(P>0.05).Ratio of Pa O2/Fi O2 of HFNC group and NRB group was 313.49±33.93 and 298.15±34.36 respectively.However,the use of HFNC resulted in improved Pa O2/Fi O2 and lower Pa CO2 level post extubation(P<0.05).Patients among this 126 patients who needed reintubation accounted for 11 cases(3cases of HFNC group,8 cases of NRB group).The intubation rate of HFNC group was significantly lower than that of NRB group,there were fewer patients required re-intubation in HFNC group(P<0.05).Conclusion Compared with NRB,high flow nasal cannula could more effectively improve oxygenation,and reduce the need for re-intubation in the post-extubation period in critically ill patients in the ICU. |
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