Comparison Of High-flow Nasal Cannula Oxygen Therapy And Non-invasive Ventilation In Respiratory Failure: A Retrospective Study

Objective:To compare the efficacy of nasal high flow oxygen therapy?HFNC?and noninvasive ventilation?NIV?in the treatment of respiratory failure.Methods:Retrospective analysis of patients with respiratory failure with or without hypercapnia treated in RICU?Respiratory intensive care unit?from December 2018 to December 2019?PaO₂/FIO₂?P/F?<300,arterial blood gas pH>7.25,with or without PaCO₂ 50⁶0 mmHg?,HFNC?HFNC group?or NIV?NIV group?were accepted as first-line respiratory support.Patients were divided into two groups:?1?HFNC group?with HFNC treatment within 4 hours after RICU admission and continued for more than 2 hours,and at least 4 hours within the first 24 hours?;?2?NIV group?with NIV treatment within 4hours after RICU admission and continued for more than 2 hours,and at least 4 hours within the first 24 hours?.Following indicators were observed:?1?The treatment failure rate of the two groups:?treatment failure is defined as the overall prognosis,including:?i?intubation,?ii?switch to another treatment without improvement,or?iii?death during HFNC or NIV?;?2?Data collection:baseline?0?,1 and 4h oxygenation index,PaCO₂,pH,SpO₂,life signs?HR,R?;?3?How long the patient used HFNC or NIV within 24 hours after ICU admission,and the occurrence of adverse reactions during treatment.?4?28-day mortality.Results:?1?75 patients were enrolled,including 40 in the HFNC group and 35 in the NIV group.There was no statistical difference between the two groups in age,gender,and APECH II score.The main underlying diseases include chronic obstructive pulmonary disease,pneumonia,and pulmonary interstitial fibrosis.?2?Comparison of treatment failure rate between the two groups,treatment failure rate in the HFNC group was 25.0%?10/40?,treatment failure rate in the NIV group was 28.6%?10/35?,there was no statistical difference between the two groups?P>0.05?;Comparison of endotracheal intubation rate between the two groups,endotracheal intubation rate in the HFNC group was 22.5%?9/40?,endotracheal intubation rate in the NIV group was 25.7%?9/35?,there was no statistical difference between the two groups?P>0.05?.?3?There was no statistical difference in oxygenation index,PaCO₂,pH,SpO₂ between the two groups at each time point.The vital signs?HR,R?at 1 hour in the HFNC group was better than that of the NIV group,and the vital signs?HR,R?at 4 hours were no difference in these two groups.?4?The respiratory support time in the HFNC group was significantly longer than that in the NIV group within24 hours?P<0.05?.The incidence of adverse reactions?skin pressure sores,claustropHobia,eye irritation symptoms?in the HFNC group during treatment was lower than that in the NIV group?P<0.05?.?5?The 28-day mortality rate was 15.0%?6/40?,11.4%?4/35?in HFNC group and NIV group,respectively.There was no statistical difference in the 28-day mortality rate between the two groups?P>0.05?.?6?There were a total of 45 patients in the hypercapnia group.The treatment failure rate in the HFNC group was 30.4%?7/23?,and the treatment failure rate in the NIV group was 27.3%?6/22?.There was no statistical difference between the rates?P>0.05?.No statistical differences were found in PCO₂ and pH between the two groups after treatment?P>0.05?.Conclusion:HFNC has a similar treatment effect as NIV in reducing the intubation probability of patients with respiratory failure;The vital signs at 1 hour in the HFNC was better than that of the NIV,and HFNC has better treatment tolerance.For respiratory failure patients with mild hypercapnia,the HFNC group and the NIV group have similar therapeutic effects.