The Application Of High-flow Nasal Cannula In Prevention Of Extubation Failure After Mechanical Ventilation

Objective In order to understand the application of high flow nasal cannula(HFNC)in the prevention of mechanical ventilation(MV)extubation failure,we further confirmed the efficacy of HFNC in the prevention of MV extubation failure by comparing the curative effect of HFNC with that of conventional oxygen therapy(COT).Methods(1)Screening the risk factors of extubation failure of sequential COT: the clinical data of patients who failed to extubation which sequential COT after MV in intensive care unit(ICU)of the First People’s Hospital of Yichang during the period of 2016-07-01 to 2017-12-31 were collected.SPSS statistical software was used to analyze the factors leading to failure.(2)A comparative study on the efficacy of HFNC and COT: collection of ICU patients with ≥ 3 the above risk factors in the First People’s Hospital of Yichang during the period of 2018-01-01 to 2019-2-28 Patients with MV.According to the way of sequential oxygen therapy,they were divided into two groups: HFNC group(experimental group)and COT group(control group).The rates of reintubation,postextubation respiratory failure,median postextubation IC U length of stay(LOS),hospitalization LOS and postextubation mortality were compared between the two groups.Results(1)The risk factors of sequential COT after extubation were successfully screened :in the period 2016-07-01 to 2017-12-31,there were 826 patients received MV to extubation,44 cases of extubation failured and 180 extubation successed patients were included in the study,and the risk factors were analyzed by SPSS statistical software: length of MV of greater than 7 days(OR = 1.663,95% CI = 1.241-2.229,p = 0.001),and the body temperature was higher than 38.0 ℃ at the time of extubation(OR = 8.292,95% CI = 3.338-20.59,p = 0.001),and acute physiology and chro nic health evaluation II(APACH II)greater than 12 points on extubation day(OR = 1.436,95% CI = 1.203-1.715,p = 0.001).chronic cardiopulmonary-related diseases(O R = 3.774,95% CI = 1.196-11.911,p = 0.023),nutritional risk(OR = 7.61,95% CI = 2.744-16.436,p = 0.022),poor airway self-cleaning(OR = 3.636,95% CI = 1.094-12.087,p = 0.035),where there was a significant correlation with fever and nutritional risk during extubation.(2)The effect of the HFNC group(experimental group)and the COT group(control Ⅲ group)was compared:98 cases of the sequential HFNC group and 104 cases of the sequential COT group were collected from the First People’s Hospital of Yichang since 2018-01-01 to 2019-2-28.Primary results: reintubation rate(13.27% vs 26.92%,p = 0.016),postextubation respiratory failure(20.40% vs.38.46%,p = 0.005);secondary results: median postextubation IC U LOS(3.57 vs.5.07,p = 0.001),hospitalization LOS(29.66 vs.29.06,p = 0.764),mortality(8.16% vs.9.61%,P = 0.717).ConclusionThe application of HFNC in prevention of extubation Failure after MV is superior to that of COT,which is reflected in lower reintubation rate and shorter postextubation ICU LOS.