Preliminary Study On The Clinical Application Of High-flow Nasal Cannula Oxygen Therapy In Respiratory Failure

Objective and SignificanceTo compare the clinical intervention effects of high-flow nasal cannula oxygen therapy（HFNC）with normal mask oxygen therapy and non-invasive ventilator on patients with respiratory failure（RF）,and to provides an effective basis for the application of HFNC.Research MethodsThis study is a cohort study.From January 2017 to January 2019,patients with respiratory failure（RF）in the Department of Respiratory Medicine of Shaanxi Provincial People’s Hospital were selected as subjects.The patients were divided into 3 groups based on conventional treatment（including control of infection,spasmolysis,expectoration,and suppression of airway inflammation）,one group is common mask（group A）,one group is non-invasive ventilator（group B）,and the other group is HFNC（group C）.The general baseline data of three groups of patients and after oxygen therapy are compared.The clinical parameters of 1h,2h,6h,12h,24h,48h and 72h were analyzed,and the differences in sputum viscosity,degree of humidification and comfort were analyzed after 72 hours.Results1.General data comparison:There were no statistical differences in age,gender,body mass index（BMI）,duration of disease,and simplified acute physiology score II（SAPS II）among the three groups.（P>0.05）.2.Blood gas analysis:（1）Comparison of the arterial oxygen partial pressure（PaO₂）:The PaO₂ of the three groups increased with time.After 1h,the PaO₂ of the common mask group and the non-invasive mechanical ventilation group were statistically significant（P<0.001）,the common mask group was statistically significant compared with PaO₂ in the HFNC group（P<0.001）.There was a statistically significant difference in PaO₂ between the non-invasive mechanical ventilation group and the HFNC group after 48 hours（P=0.036）.（2）The comparison of oxygenation index（PaO₂/FiO₂）:The PaO₂/FiO₂ levels of the three groups of patients increased with time.At 24h,the PaO₂/FiO₂ of the common mask group and the non-invasive mechanical ventilation group were statistically significant（P=0.042）.There was a statistically significant difference in PaO₂/FiO₂ between the common mask group and the HFNC group（P=0.031）.There was no significant difference in PaO₂/FiO₂ between the non-invasive mechanical ventilation group and the HFNC group within 72 hours（P>0.05）.（3）Comparison of arterial oxygen saturation（SaO₂）:The SaO₂ of the three groups increased with time.After 1h,the common mask group had statistical significance compared with SaO₂ in the non-invasive mechanical ventilation group（P<0.001）.The common mask group had SaO₂ compared with the HFNC group.Statistical significance（P<0.001）.There was a statistically significant difference in SaO₂ between the non-invasive mechanical ventilation group and the HFNC group after 48 hours（P=0.030）.（4）There was no statistical difference in pH within 72 hours（p>0.05）.3.Physiological indicators:（1）The respiratory rate（RR）was compared:The RR of the three groups decreased with time.The RR of the common mask group and the HFNC group was statistically significant at 12 hours（P=0.022）.The RR of the non-invasive mechanical ventilation group and the HFNC group was statistically significant at 48 hours（P=0.007）.There was no significant difference in RR between the common mask group and the non-invasive mechanical ventilation group within 72 hours（P>0.05）.（2）The heart rate（HR）was compared:The HR of the three groups decreased with time.The HR of the common mask group and the HFNC group was statistically significant at 24 hours（P=0.035）.The HR of the non-invasive mechanical ventilation group and the HFNC group was statistically significant at 48 hours（P=0.039）.There was no significant difference in HR between the common mask group and the non-invasive mechanical ventilation group at 72 hours（P>0.05）.4.Viscosity of sputum after 72 hours of treatment:There was no significant difference between the common mask group and the non-invasive mechanical ventilation group（Z=-1.909,P=0.056）,and the common mask group and HFNC group（Z=-5.603,P<0.001）and the non-invasive mechanical ventilation group and the HFNC group（Z=-3.425,P=0.001）were statistically significant,indicating that HFNC is superior to the common mask and non-invasive ventilator in the dilution of sputum.5.Humidification degree after 72h treatment:There was no significant difference between the common mask group and the non-invasive mechanical ventilation group（Z=-0.301,P=0.763）,and the common mask group and the HFNC group（Z=-3.558,P<0.001）.The non-invasive mechanical ventilation group and the HFNC group（Z=-3.168,P=0.002）were statistically significant,indicating that HFNC is superior to the common mask and non-invasive ventilator in terms of degree of humidification.6.Comfort after 72 hours of treatment:There was no significant difference between the common mask group and the non-invasive mechanical ventilation group（Z=-0.739,P=0.460）,the common mask group and the HFNC group（Z=-5.626,P<0.001）and non-invasive Mechanical ventilation group and HFNC group（Z=-5.422,P<0.001）were statistically significant,indicating that HFNC is superior to common mask and non-invasive ventilator in terms of comfort.ConclusionsBased on routine treatment and care,patients with respiratory failure can alleviate clinical symptoms through three oxygen treatments,compared to:1.In the improvement of patients PaO₂,PaO₂/FiO₂,SaO₂,nasal high-flow humidification oxygen therapy and non-invasive mechanical ventilation have more significant effects than common mask;2.In improving patients with RR,HR,sputum viscosity,airway humidification degree,comfort,nasal high flow humidification oxygen therapy is better than non-invasive mechanical ventilation,common mask;3.The three groups of oxygen therapy have similar effects in improving pH.It can be seen that the HFNC has a good effect and is easily accepted by patients,so it can be used as a first-line choice for oxygen therapy and respiratory support of such patients,and has broad clinical prospects.