Efficacy And Safety Of High Flow Nasal Cannula Oxygen Therapy Versus Non-invasive Ventilation For Pneumoconiosis With Hypercapnic Respiratory Failure

BackgroundPneumoconiosis is a group of occupational pulmonary diseases,mainly diffuse fibrosis of lung tissue,caused by long-term inhalation of productive dust with different pathogenicity in occupational activities.It is the most serious and common occupational disease in China.Up to 2017,more than 850,000 cases of pneumoconiosis were reported in China,accounting for 89.8%of the total occupational diseases.Although pneumoconiosis has definite causes and can be prevented,there are still 19468 new cases of pneumoconiosis in 2018,accounting for82.85%of the new occupational diseases in the whole year.A large group of pneumoconiosis has become a serious public health problem in China.For many years,domestic and foreign scholars have never stopped exploring the treatment of pneumoconiosis,but so far there is no effective method to cure pneumoconiosis and reverse the fibrosis of pneumoconiosis tissue.Therefore,symptomatic treatment,improvement of clinical symptoms,relieving pain,delaying the progress of the disease,and improving the quality of life have become the goal of pneumoconiosis treatment.Hypercapnic respiratory failure is a common complication of pneumoconiosis and an important cause of death of pneumoconiosis patients.Non-invasive positive pressure ventilation?NIV?is an effective treatment to improve hypercapnic respiratory failure,and has been widely used in the treatment of pneumoconiosis with hypercapnic respiratory failure.However,due to the poor tolerance of non-invasive positive pressure ventilation mask and claustrophobia,application of non-invasive positive pressure in some patients is limited.As a new non-invasive breathing supporting method,nasal high-flow oxygen therapy?HFNC?has been increasingly used in the treatment of respiratory failure caused by different causes,because it can effectively enhance the tolerance patients and avoid claustrophobia,and has the advantages of providing precise and adjustable oxygen concentration,sufficient warming and humidification of high-flow gases.In this study,64 patients with pneumoconiosis complicated with hypercapnic respiratory failure were collected.They were randomly divided into two groups and treated with NIV or HFNC respectively.Based on this,we explore the efficacy and safety of HFNC in pneumoconiosis patients with hypercapnic respiratory failure.ObjectiveComparing the efficacy of HFNC or NIV in the treatment of pneumoconiosis with hypercapnic respiratory failure and exploring the efficacy and safety of HFNC in the treatment of pneumoconiosis,this article discussed the clinical value of HFNC in respiratory support therapy for pneumoconiosis patients with hypercapnic respiratory failure.MethodsA total of 64 pneumoconiosis patients with hypercapnic respiratory failure hospitalized in Twelve People's Hospital Affiliated to Guangzhou Medical University from January 2017 to August 2018 were selected.They were randomly divided into two groups,32 cases in HFNC group and 32 cases in NIV group.They were given HFNC or NIV respiratory supporting treatment respectively.?1?The changes of arterial blood pH,oxygenation index,arterial carbon dioxide partial pressure?PaCO₂?,respiratory rate?RR?and heart rate?HR?were compared between the two groups before and after treatment for 2,6,12 and 24 hours.?2?The oral dryness and comfort of the two groups after 12 hours of treatment were compared.?3?Comparisons of complications,reasons for changing to invasive ventilation and 28-day mortality between the two groups during treatment were compared.Based on the above results,the efficacy and safety of HFNC in the treatment of pneumoconiosis with hypercapnic respiratory failure were analyzed and evaluated.Results1.There was no significant difference in age,sex,proportion of pneumoconiosis in each stage,basic diseases and APACHE II between HFNC group and NIV group?p>0.05?.There was no significant difference in HR,SPO₂,RR,MAP,PH,PCO₂ and oxygenation index between the two groups before treatment?p>0.05?.2.The oxygenation index of patients in HFNC group and NIV group increased gradually?F=55.84,P<0.05?,and there was no difference between the two groups?F=0.70,P=0.41?;PaCO₂ of patients in both groups decreased gradually?F=42.08,P<0.05?,and there was no difference between the two groups.?F=0.74,P=0.39?;and there was no significant difference in oxygenation index and PaCO2 between the two groups at different time points after treatment?p>0.05?.3.RR in HFNC group and NIV group decreased gradually?F=417.00,P<0.05?,and there was no difference between the two groups.?F=0.84,P=0.36?;HR of the two groups decreased gradually?F=393.71,P<0.05?,and there was no difference between the two groups.?F=1.32,P=0.26?.4.After 12 hours of treatment,the degree of dry mouth in NIV group was significantly higher than that in HFNC group?P<0.05?.The comfort of HFNC group was significantly better than that of NIV group?P<0.05?.5.There was no significant difference between HFNC group and NIV group in changing the proportion of invasive ventilation?p=0.77?.There was no difference in the causes of changing to invasive ventilation?p>0.05?.6.Gastric distention in NIV group was significantly higher than that in HFNC group?p=0.03?.There was no difference in the incidence of facial lesions and pneumothorax between the two groups?p>0.05?.There was no significant difference in 28-day survival rate between the two groups?Log Rank=0.09,P=0.764?.Conclusion1.HFNC can improve oxygenation index,reduce PaCO₂ and improve the symptoms of shortness of breath and palpitation in patients with pneumoconiosis combined with hypercapnic respiratory failure.Its effect is similar to that of NIV.2.Patients with pneumoconiosis complicated with hypercapnic respiratory failure treated with HFNC or NIV are no significant difference in treatment of failure rate and mortality rate within 28 days.3.HFNC is more comfortable than NIV,and the incidence of gastric flatulence is lower.4.Compared with NIV,the efficacy and safety of HFNC in the treatment of pneumoconiosis combined with hypercapnic respiratory failure deserve to be affirmed.