Effect Of Hypertonic Saline Inhalation For Mechanical Ventilation Patients With Severe Community-acquired Pneumonia

Objective:The purpose of this study was to investigate the efficacy of nebulizing 3%Hypertonic Saline?HS?and Normal Saline?NS?solution in the treatment of Severe Community Acquired Pneumonia?SCAP?with invasive mechanical ventilation.Methods:This was a prospective randomized controlled trial.Patients with mechanical ventilation?SCAP?who visited the EICU department of the first hospital of JiLin university from November 2017 to September 2018 were selected as the research objects.According to the random number table method,SCAP patients were randomly divided into HS group and NS group.In HS group,5mL 3%sodium chloride solution was inhaled for 3 times per day.In NS group,5mL 0.9%sodium chloride solution was inhaled for 3 times per day,and continuous intervention was performed for 5 days.The patient's sputum volume,blood gas analysis,white blood cell count,body temperature,Clinical Pulmonary Infection Score?CPIS?and sputum viscosity were evaluated before intervention and 1 day,3 days,and 5 days after intervention.Results:A total of 63 patients completed a 5-day intervention,including 31 in the 3%HS group and 32 in the NS group.?1?There were no significant differences in demographic characteristics and pre-intervention clinical severity scores between the two groups?P>0.05?.?2?After 1 day,3 days,and 5 days of intervention,the weight of sputum was compared between the two groups,and the difference was statistically significant.?z values were-1.556,-3.744,-4.887,P<0.05?.?3?After 1 and 3 days of intervention,the arterial partial pressure of oxygen?PaO₂?was compared between the two groups.The difference was not statistically significant?P>0.05?.After 5 days of intervention,the PaO₂ of the two groups were compared and the difference was statistically significant?3%HS group:104.21±34.08 mmHg,0.9%NS group:97.62±35.08 mmHg;t=0.763,P<0.05?.?4?After 1 day of intervention,the oxygenation index?PaO₂/FiO₂?of the two groups was compared,the difference was not statistically significant?P>0.05?.PaO₂/FiO₂ was compared between the two groups on the 3th and 5th day of intervention,and the differences were statistically significant?P<0.05?.?5?After 1 day of intervention,the PaCO₂ of both groups showed downtrend,but there was no significant difference between the two groups?P>0.05?.?6?After 1 and 3 days intervention,there was no significant difference in white blood cell counts between the two groups?P>0.05?.On the 5th day after intervention,the white blood cell count of 3%HS group was lower than 0.9%NS group.Statistically significant?t=-2.097,P=0.040?.?7?After 1 and 3 days of intervention,there was no significant difference in body temperature between the two groups?P>0.05?.On the 5th day after the intervention,the body temperature of the two groups was compared,and the difference was statistically significant?t=-4.419,P=0.000?.?8?Before the intervention,the CPIS scores of the two groups were compared without significant difference?P>0.05?.On the 5th day after intervention,the CPIS scores of the two groups were compared,and the difference was statistically significant?3%HS group:4.18±1.17,0.9%NS group:5.21±1.36;t=-3.342,P=0.02?.?9?On the 1th,3th and 5th day after intervention,the sputum viscosity of the two groups showed downtrend,but the difference between the two groups was not statistically significant?P>0.05?.Conclusion:Inhalation of 3%hypertonic saline can improve the weight of sputum,PaO₂,PaO₂/FiO₂,CPIS score and body temperature in patients with SCAP mechanical ventilation,promote sputum drainage,improve oxygenation and reduce inflammation.In the future,a multi-center large sample clinical study can be conducted to investigate the effects of different concentrations of hypertonic saline aerosol inhalation on patients with SCAP mechanical ventilation in order to obtain the optimal hyperosmotic saline concentration for clinical practice.