Evaluation Of Sequential Application Of High Flow Oxygen Therapy After Tracheal Extubation In Patients With Stanford Type A Aortic Dissection

ObjectiveThe effect of high flow oxygen?HFO?was compared with that of conventional oxygen mask in patients with tracheal tube extubation after Stanford type A aortic dissection?TAAD?.This can verify the safety and effectiveness of HFO as a new respiratory support mode in sequential ventilation after TAAD operation.This can provide theoretical basis and experience for guiding clinical work.MethodsIt is a randomized controlled study.100 patients with TAAD were selected from January 2017 to December 2019 in the heart surgery department of a top three hospital in Qingdao,who were evacuated from the ventilator to remove the endotracheal intubation.According to random number method,they were divided into conventional oxygen inhalation method?50 cases?and high flow oxygen therapy method?50 cases?.After extubation of tracheal tube,the control group was given ordinary mask type oxygen inhalation,while the experimental group was given 48 hours of sequential application of high flow oxygen therapy after extubation of tracheal tube.We compared the differences between the two groups in respiratory rate?RR?,partial pressure of oxygen/fraction of inspiration oxygen?PaO2/FiO2?,potential of hydrogen?PH?,oxygen partial pressure?PaO2?,oxygen saturation?SaO2?and partial pressure of carbon dioxide in artery?PaCO2?at 0,1,6,12,24,48,72 hours after extubation of tracheal tube;RR,PaO2/FiO2,PH,PaO2,SaO2 and PaCO2 of each group at different time points were compared;The comfort level?degree of throat pain,degree of dry mouth and nasal cavity?after 12 h,24h and 48 h were compared between the two groups;The viscosity of sputum in the first 24hours,the second 24 hours and the third 24 hours was compared between the two groups.The incidence of moderate to severe hypoxemia and the incidence of secondary intubation in 72 hours were compared between the two groups.Results1.In this study,3 patients in the experimental group and 12 patients in the control group were excluded due to the change of oxygen treatment regimen.47 patients in the experimental group and 38 patients in the control group were finally included.There was no significant difference in general information between the two groups?P>0.05?,such as age,sex,body mass index?BMI?,concomitant diseases?hypertension,diabetes,coronary heart disease?,smoking history,operation time,operation type,PaO₂ in resting state before operation,acute physiology and chronic health evaluation??APACHE??score before operation,extracorporeal circulation time,aorta blocking time and postoperative mechanical ventilation time.2.Research results show that there was no significant difference in RR,PaO₂/Fi O₂,PH,PaO2,SaO2,PaCO2 between the two groups?P>0.05?after extubation?0 h?;At 1 h after extubation,there was no significant difference in RR,PaO₂/FiO₂,PH,PaO₂ and SaO2 between the two groups?P>0.05?.After extubation for 6 h,12 h,24 h,48 h and 72h,the differences in RR,PaO₂/FiO₂,PaO₂,SaO₂ and PaCO₂ between the two groups were statistically significant?P<0.05?,while the differences in PH between the two groups were not statistically significant?P>0.05?.3.The results showed that there were statistically significant differences in RR,PaO₂/FiO₂,PaO₂,SaO₂ and PaCO₂ at different time points between the two groups?P<0.05?,but no statistically significant differences in PH?P>0.05?.4.The results showed that the scores of laryngopharyngeal pain in the HFO group at12 h after extubation,24 h after extubation and 48 h after extubation were all lower than those in the normal mask group,and the differences were statistically significant?P<0.05?.After extubation for 12 h,after extubation for 24 h,and after extubation for 48 h,the dry degree of nasal cavity and mouth in the HFO group was lower than that in the normal mask group,and the difference was statistically significant?P<0.05?.5.The results showed that the sputum viscosity scores of HFO group in the first 24hours,the second 24 hours,and the third 24 hours were lower than those of the ordinary mask group,the difference was statistically significant?P<0.05?.6.The results showed that the incidence of moderate and severe hypoxemia and secondary intubation in HFO group within 72 hours was lower than that in the general mask group.The difference between the two groups was statistically significant?P<0.05?.ConclusionHFO can improve respiratory and oxygenation indexes of patients with postoperative extubation TAAD state,reduce the incidence of moderate to severe hypoxemia.HFO is more comfortable than conventional mask oxygen therapy,more conducive to airway management,more safe and effective application.HFO can be used as a ventilation method for patients with tracheal intubation after extraction of TAAD.