Sequential Treatment Of Hfnc In Patients With High Risk Of Mechanical Ventilation Extubation

Background:It is still a difficult problem to choose the right sequential respiratory support for patients with high risk of mechanical ventilation(MV)extubation.Traditional transnasal and mask oxygen therapy is lack of strong respiratory support,and the rate of re intubation is high.High flow oxygen therapy(HFNC)is an innovation of traditional oxygen therapy and noninvasive ventilation technology.Domestic and foreign studies have pointed out that HFNC and NPPV as sequential respiratory support after mechanical ventilation extubation are equally effective,while HFNC has fewer adverse reactions.In this study,HFNC sequential mechanical ventilation was applied to patients with high-risk of extubation for follow-up respiratory support treatment,to explore whether the clinical effect of HFNC sequential treatment is better than NPPV.Objective:In this study,NPPV was selected as a control study to explore the effectiveness and safety of sequential ventilation in patients with high risk of mechanical ventilation off-line extubation.The purpose of this study is to provide a reference for the choice of follow-up respiratory support for patients with high risk of mechanical ventilation extubation.Method:Using prospective randomized controlled study method,the subjects were patients who had received mechanical ventilation treatment from August 2018 to October 2019 in ICU of Fuyang People's Hospital and achieved the indication of off-line extubation,and these patients all had high risk factors of re intubation after extubation.High risk factors include at least one of the following conditions:age?65 years old;APACHE II score?12 points;body mass index?30kg/m~2;number of failure of spontaneous breathing test(SBT)?3 times;heart failure or COPD;mechanical ventilation time?7 days,etc.According to the exclusion criteria,64 patients were finally enrolled in the study.They were divided into the experimental group(HFNC group)and the control group(NPPV group),32 cases in each group.HFNC and NPPV were used as sequential therapy after extubation.The clinical indicators included:1.High risk factors of patients're intubation and general baseline indicators before extubation;2.Vital signs,blood gas analysis,sputum viscosity,comfort score and other indicators at 2h,24h and 48h after extubation;3.Outcome indicators:re intubation rate and mortality within 28 days,incidence of complications(delirium,aspiration,abdominal distention,facial compression,etc.).The statistical difference of the observation indexes between the two groups was compared.The data of the above indexes were analyzed and statistically processed by spss23.0.The difference was statistically significant(P<0.05).Result:1.There was no significant difference in Pa CO2,Pa O2,Pa O2/Fi O2 and map between the groups before and after the sequential treatment(P>0.05),but there was significant difference in RR,HR and comfort scores at 48h(P<0.05),The changes of Pa CO2,Pa O2 and Pa O2/Fi O2 were statistically significant(P<0.05);.In HFNC group,the difference between RR at extubation and 48 hours after extubation was statistically significant(P<0.05).In NPPV group,there was no significant difference in RR,HR and map(P>0.05),and there was significant difference in comfort score(P<0.05).2.The rate of intubation and mortality in HFNC group were lower than that in NPPV group,but there was no significant difference(P>0.05);the incidence of delirium,aspiration,abdominal distention,facial pressure sore and other complications in HFNC group were lower than that in NPPV group,but the difference of abdominal distention was statistically significant(P<0.05),and the difference of other complications was not statistically significant(P>0.05).Conclusion:The sequential use of HFNC in patients with high risk of mechanical ventilation off-line extubation is no less effective and safe than NPPV.Therefore,HFNC can be used as one of the effective means of respiratory support for such patients after off-line extubation,and can be used as a beneficial supplement to traditional NPPV sequential ventilation.