Effects Of High Nasal Flow Oxygen Therapy On AECOPD Patients With Type ? Respiratory Failure

BackgroundChronic obstructive pulmonary disease(COPD)is a common,preventable and therapeutic disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases.Acute exacerbation of chronic obstructive pulmonary disease(AECOPD)is the aggravation of respiratory symptoms such as cough and sputum,which leads to the need for additional treatment on the basis of the original treatment in the stable period.Oxygen therapy is a common treatment for COPD patients.High nasal flow oxygen therapy(HFNC)has developed rapidly in the past few years.It has been used widely in children and infants,which would substitute nasal continuous positive airway pressure treatment.Meanwhile,as many advantages of HFNC well development,HFNC is also being more and more used for the treatment of adults,mainly used in the study of acute hypoxic respiratory failure in adults.For example,warming and humidifying function can improve the patient's oxygen therapy comfort;high velocity aero-oxygen mixture provided by HFNC can effectively relieve hypoxia.However,the application of HFNC in AECOPD with type ? respiratory failure is rarely studied.This work mainly studied the application of HFNC in AECOPD with type ? respiratory failure to verify whether HFNC can effectively improve hypoxia and carbon dioxide retention in these patients.ObjectiveEvaluate the effects of HFNC on hypoxia and carbon dioxide retention in AECOPD patients with type 2 respiratory failure.MethodsThe study was a randomized controlled study.AECOPD patients with type 2 respiratory admitted to the department of respiratory medicine of The First Affiliated Hospital Of Henan University from November 2018 to January 2020 were selected as the study subjects.All these patients refuse to use or for other reasons can not tolerate noninvasive positive pressure ventilation therapy.Prior to the start of treatment,COPD related professional knowledge and treatment cautions should be available to the patients in detail during the process of oxygen therapy.The patients were divided into two groups by random number table and their willingness: traditional oxygen with nasal catheter group(the neutral group)and HFNC group(experimental group).There were 50 patients in both groups.Both groups were given conventional treatment such as anti-infection,antitussive treatment,antispasmolysis and antiasthmatic treatment,maintenance of water and electrolyte balance,and nutrition support.And on this basis patients in control group were treated with traditional nasal oxygen therapy.Patients in the neutral group were treated with conventional oxygen therapy in addition to the basic treatment of drug therapy.Parameters setting: keeping oxygen concentration between 28% and 35% and guaranteeing the Pulse oxygen saturation(SpO2)condition between 88% to 92% according to the oxygen flow and oxygen concentration during normal nasal catheter oxygen therapy.Daily treatment should be more than 15 hours(the oxygen concentration can be increased appropriately to ensure SpO2,if unable to reach the goal oxygenation).Patients in the experimental group were treated with HFNC in addition to the basic treatment of drug therapy.Parameters setting: Parameters should be adjusted according to the patient's condition and degree of tolerance.Keeping oxygen concentration between 28% and 35% and guaranteeing the SpO2 condition between 88% to 92% according to the oxygen flow and oxygen concentration during normal nasal catheter oxygen therapy,daily treatment should be more than 15 hours(the oxygen concentration can be increased appropriately to ensure SpO2,if unable to reach the goal oxygenation).The treatment should be adjusted treatment plan timely according to the patient's general condition.Clinical indexes including heart rate(HR),respiratory rate(RR),Arterial oxygen saturation(SaO2),Partial pressure of oxygen(PaO2),Partial pressure of carbon dioxide(PaCO2),time for the relief of dyspnea,the degree of comfort and the cause of unease,time of the patients assisted breathing with ventilator were recorded.Meanwhile,the experimental group was divided into 3 groups according to their PaCO2 to compared their improvement interval for treatment(the first group: 50 mm Hg < PaCO2 ? 60 mm Hg,the second group: 60 mm Hg < PaCO2 ? 70 mm Hg,the third group: 70 mm Hg < PaCO2 ? 80 mm Hg,and the fourth group 4: 80 mm Hg < PaCO2 ? 90 mm Hg).SPSS 24.0 software was used for statistical analysis of the collected data to find the optimal treatment interval for AECOPD patients with type 2 respiratory.Results1.There was no significant difference in gender,age,course of disease and the clinical indexes,including HR,RR,SaO2,PaO2 and PaCO2,in these two groups before treatment(P > 0.05).PaCO2 in the experimental group has no obvious difference(P > 0.05)at1 h,4 h after treatment.However,the difference was statistically significant at 24 h,48 h,72 h after treatment(P < 0.05).There were significantly improved at 1 h,4 h,24 h,48 h,72 h in PaO2 and SaO2 after treatment(P <0.05);2.In the control group,there were significant difference in PaCO2 at 1h,4 h and 24 h(P > 0.05),but PaCO2 was significantly improved at 48 h and 72 h after treatment(P < 0.05).Meanwhile,PaO2 values were also increased at 1 h,4 h,24 h,48 h and 72 h after treatment with statistically significant differences(P < 0.05);3.PaO2,PaCO2 and SaO2 in both the experimental group and the control group were improved,while the effective treatment in experimental group was better than control group at 72 hours after treatment(P < 0.05);4.According to the comfort rating scale,the experimental group was superior to the control group,with statistically significant difference(P < 0.05);5.The number of cases requiring respiratory support upgrade in the two groups was less in the experimental group than in the control group,and the failure rate of HFNC was lower than that of the common nasal catheter oxygen therapy,with statistically significant differences(P < 0.05);6.The most obvious decreasing range of PaCO2 in the experimental group was 60 mm Hg<PaCO2?90 mm Hg.Conclusions1.HFNC can effectively improve PaO2,PaCO2,SaO2,HR,RR and dyspnea in patients with AECOPD with type ? respiratory failure;2.HFNC can be given to patients with AECOPD combined with type ? respiratory failure under the condition of close monitoring of vital signs and laboratory examination;3.HFNC is more comfortable than conventional nasal catheter oxygen therapy,which is easier for patients to accept.