The Clinical Study On The Treatment Of Patients With Acute Respiratory Failure In ICU By High-flow Nasal Cannula Oxygen Therapy

ObjectivesIn this study,patients with acute respiratory failure in ICU were treated with high-flow nasal cannula oxygen therapy(HFNC)and non-invasive positive pressure ventilation(NPPV),respectively.The clinical effect of these two respiratory treatments in patients with acute respiratory failure in ICU were compared for explore the clinical efficacy and advantages of these two methods of treatment,and to provide basis for further clinical applications.MethodsBy using randomized controlled study,and according to the inclusion and exclusion criteria,seventy-two patients with acute respiratory failure in ICU of an upper first-class hospital in Shandong Province from December 2017 to September 2018 were selected to collect relevant clinical data.These patients were randomly divided into two groups according to table of random number method after informed consents from patients or their families.Thirty-six patients in the experimental group were treated with HFNC by the HFNC instrument(Fisher&Payker,New Zealand),thirty-six patients in th e control group were treated with NPPV by the noninvasive ventilator(V60,Philips,USA).The patients in both groups were given comprehensive treatment and nursing,such as etiology treatment,anti-inflammatory,antispasmodic and antiasthmatic,expectorant,correction of electrolyte disorder and nutritional support.During the treatment,the heart rate,blood pressure,respiratory rate,blood oxygen saturation,gas flow,oxygen concentration and other parameters were monitored and recorded every hour.At the beginning of treatment and 0.5h,1h and 24h after treatment,the pH value of arterial blood gas,PaO2,PaCO2,SaO2 and other indexes were measured,and the oxygenation index P/F was calculated.The improvement of PaO2,PaCO2,SaO2,P/F were compared between the two groups;after the correction of hypoxemia,the patient’s condition improved and transferred to the general ward;otherwise,if hypoxemia was difficult to corrected,tracheal intubation should be used for invasive mechanical ventilation.The number of intubation cases and stay in ICU of the two groups were counted respectively,and the differences of them were compared.Hamilton Anxiety Scale(HAMA)was used to evaluate the anxiety status of the two groups at the beginning of treatment and 24h after treatment.All data were analyzed by SPSS 22.0 software.ResultsGeneral data of patients with acute respiratory failure before treatment:there was no significant difference in age,gender,weight,APACHE Ⅱ score and smoking history(P>0.05)After treatment,efficacy indexes of the two groups were compared:1.Analysis of arterial blood gas index results:Arterial blood oxygen saturation in the two groups of patients treated for 0.5h,1h,and 24h were significantly improved.The improvement of the nasal high-flow humidified oxygen therapy group was better than that of the noninvasive positive pressure ventilation group(P<0.05),which was statistically significant;After 0.5h of treatment,the PaO2 of the two groups began to rise,and it increased significantly in 24 hours.The patients in the two groups were significantly improved.The patients in the group of HFNC were better than those in the group of NPPV,which was statistically significant(P<0.05).Comparison of PaCO2:The PaCO2 in the treatment group decreased significantly from the beginning of treatment to 24h,which was statistically significant.In the NPPV group,the PaCO2 had no significant improvement within 24h.2.Comparison of oxygenation index between the two groups:From the beginning to 24h of treatment,both methods could improve the oxygenation index of patients,and the effect of HFNC group was more obvious(P<0.05).3.Comparison of intubation rate between two groups:Compared with NPPV group,HFNC group could significantly reduce the intubation rate(P<0.05).4.Comparison of bed days in ICU:There was no significant difference between the two groups(P>0.05)5.Comparison of anxiety scores between the two groups:After 24h of treatment,HFNC group could improve the patients’ anxiety and reduce the Hamilton Anxiety Scale(P<0.05).ConclusionsIn this study,it was found that for the patients with acute respiratory failure in ICU,the treatment of HFNC and NPPV both had better clinical effect.Compared with NPPV,HFNC has the following advantages.1.The respiratory indexes of patients such as PaO2,SaO2,PaCO2 and oxygenation index were improved;2.The intubation rate of patients was significantly reduced;3.Significantly reduce patients’ anxiety;It follows that the treatment of acute respiratory failure in ICU by HFNC is effective and more repetitive research can be carried out.