Assessment By Lung Ultrasound To Indicate High-flow Nasal Canal Oxygen Therapy And Non-invasive Ventilation For Preventing Extubation Failure In Early 48 Hrs After Extubation

Objective(s):To reducing the incidence of extubation failure and reintubation by using HFNCO and NIV in early 48h after extubation.This category of patients was identified as patients with a LUS ? 15 at the end of a successfully passed of SBT.Method(s):89 patients with invasive mechanical ventilation were admitted to EICU of the First Affiliated Hospital of Kunming Medical University from 1st September 2014-1st March 2017,they were treated with invasive mechanical ventilation more than 48h and successfully passed SBT,lung ulrasound had been done at the end of SBT,and patients with LUS?15 were enrolled into this trial.These patients were randomly divided into A,B,C,D four groups.On the basis of the treatment of primary diseases,anti-infection,nutritional support and so on,at the same time,they were treated in the guidance of SpO2,PaO2,OI and a series of index which can predict the extubation failure in the process of the treatment.The group A using traditional oxyen mask same as the standard treatment,group B used the NIV during the first 48h after extubation,and the experimental group C used the HFNCO,meanwhile the group D used the NIV combining HFNCO during the first 48h.In comparing the effects and outcomes between the four groups of patients who accepted the different oxygen treatments.Results:1.The four groups of patients had no statistical difference in demographic datas.(P>0.05).2.The value of SpO2,PaO2,in the B?C?D groups were higher than the A group's after the extubation in 1h,6h,12h,24h,48h,menawhile,the value of Respiratory Rate(RR)and PaCO2 were lower than group A,there are significant differences(P<0.05).3.In the first 48h after extubation,the incidence of extubation failure,reintubation of the group B?C?D were lower than A group.At the same time,the incidence of ventilator assosciated pneumonia(VAP),the duration of mechanical ventilation and days of ICU stay of the groupB?C?D were less than the group A,(P<0.05).4.The patients' respiratory comfort level and humidification were evaluated by the visual scales,the group C showed a great comfortable tolerance and humidification,the score was less than the rest 3 groups,(P<0.05).Conclusion:1.Patients with high risk of extubation failure being treated by the HFNCO and/or NIV continuously after extubaion is an efficient management to prevent extubation failure and reintubation compared with the traditional standard treatment.This sequential therapy also can shorten duration of mechanical ventilation and ICU stay days,reducing the complications of long time mechanical ventilation and improving patients' prognosis.2.Treating with HFNCO or NIV individualy could decrease the ratio of extubation failure and reintubation,there is no significantly different outcomes between the two kinds of treatment,but the HFNCO showed a better endurance and comfort level of the respiratory therapy.3.Lung ultrasound has prognostic significance in the process of weaning and extubation.