Comparison Of The Efficacy Of HFNC And NIPPV In Sequential Treatment Of Patients With High Risk Of Failure After Removing Their Mechanical Ventilators In ICU

Objective:Patients with respiratory failure in ICU（Intensive care unit）,if the degree of respiratory failure has reached the indication of invasive mechanical ventilation,endotracheal intubation invasive mechanical ventilation should be performed as soon as possible,and endotracheal intubation should be removed as soon as possible after the patient’s condition is stable and has passed the autonomous breathing test.There are some patients with extubation failure in ICU who have passed one or more spontaneous breathing tests.These patients are at high risk of mechanical ventilation extubation failure.In order to reduce the risk of extubation failure in these patients,this paper will explore the efficacy of sequential treatment of HFNC（High-flow nasal cannula）and NIPPV（Non-invasive positive pressure ventilation）in patients with high risk of mechanical ventilation extubation failure,and discuss the clinical benefits of HFNC for these patients,in order to better guide clinical application.Materials and methods:This study is a retrospective non-randomized cohort analysis.Patients with endotracheal intubation mechanical ventilation treated in the emergency intensive care unit of China-Japan Friendship Hospital of Jilin University from January 2021 to October 2021 were selected.HFNC or NIPPV were selected as sequential respiratory support after tracheal intubation was removed.A total of 78 qualified cases were selected strictly according to the inclusion criteria and exclusion criteria.According to the sequential respiratory support after extubation,78 cases were divided into HFNC group and NIPPV group.The following indicators were collected:（1）General condition of patients;（2）APACHE II score when entering ICU and extubating endotracheal intubation;（3）Time of mechanical ventilation and total hospital stay of ICU before extubation;（4）Arterial blood gas and vital signs before extubation and 2h,6h,12h,24h,48h after extubation;（5）The situation and causes of re-intubation within 48 hours and 7 days after extubation;（6）Death and causes within 48 hours,7 days and 28 days after extubation;（7）HFNC or NIPPV was used to treat failed cases;（8）Adverse reactions during treatment with HFNC or NIPPV.Use Excel to input data and deal with statistics.Use SPSS25.0 statistical software to analyze data.Results:（1）A total of 78 patients were enrolled,including 44 patients in the HFNC group and 34 patients in the NIPPV group.There was no significant difference in age,sex,BMI,APACE II score when entering ICU and extubation,basic diseases and complications between the two groups（P>0.05）;（2）There was no significant difference in PO₂ in arterial blood gas between the two groups at 2 h,6 h,12 h,24 h,48 h after extubation,PH at 2 h,6 h,12 h,24 h after extubation,and oxygenation index 24h,48 h after extubation（P>0.05）;（3）The values of PCO₂ and HCO₃ in arterial blood gas of two groups before extubation and 2 h,6 h,12 h,24 h and 48 h after extubation,oxygenation index of arterial gas before endotracheal intubation and 2 h,6 h and 12 h after extubation,PH value of arterial blood gas before extubation and 48 h after extubation in HFNC group were better than those in NIPPV group（P<0.05）;（4）There was no significant difference in heart rate（HR）,respiratory rate before extubation（RR）,fingertip oxygen saturation（Sp O₂）before extubation and2h,6h,6h,24h after extubation between the two groups（P>0.05）;（5）The respiratory rate（RR）at 2h,6h,12h,24h and 48h after extubation,and the fingertip pulse oxygen saturation（Sp O₂）at 12h and 48h after extubation in HFNC group were better than those in NIPPV group（P<0.05）;（6）There was no significant difference in re-intubation rate within48 hours and 7 days between HFNC group and NIPPV group（P>0.05）;（7）There was no significant difference in mortality within 48 hours and 7days between HFNC and NIPPV groups（P>0.05）,the mortality rate within 28 days in both groups was 0;（8）There was no significant difference in the failure rate of re-intubation between the two groups（P>0.05）;（9）The failure rate of changing the mode of respiratory support in both groups was 0,and there was no significant difference in the failure rate of death between the two groups（P>0.05）;（10）The skin pressure sore,flatulence and claustrophobia in HFNC group were lower than those in NIPPV group（P<0.05）.Conclusion:（1）Compared with NIPPV,HFNC is as effective as NIPPV in improving oxygenation,and is not inferior to NIPPV in reducing respiratory rate and PCO₂;（2）Compared with NIPPV,HFNC reduced the incidence of adverse events such as skin pressure sores,flatulence and claustrophobia;（3）Compared with NIPPV,there was no significant difference in re-intubation rate and mortality of HFNC;（4）HFNC is a preferred method of respiratory support for patients with high risk of extubation failure.