Clinical Observation Of Noninvasive Ventilation And Nasal High Flow Humidification Oxygen Therapy After Extubation In ICU

Background:Respiratory failure is one of the common causes of admission to intensive care unit（ICU）.Most of these patients are in critical condition and often require tracheal intubation and ventilator-assisted respiratory therapy^[1].For patients with improved primary disease and removed disease inducement,early weaning and extubation has become necessary.Spontaneous breathing test is one of the indicators commonly used to determine whether patients can successfully wean and extubate.However,20%of patients with successful spontaneous breathing test still need re-intubation.In order to achieve a smooth transition of patients,traditional oxygen therapy such as nasal catheter oxygen inhalation,Venturi mask and noninvasive ventilation has gradually taken the historical stage,while traditional oxygen therapy has the disadvantages of small flow rate,insufficient warming and humidification,poor tolerance,etc.In order to make up for the shortcomings of traditional oxygen therapy,nasal high-flow oxygen therapy（HFNC）was born and gradually applied in clinical practice.Studies^[2]have shown that compared with conventional nasal cannula oxygen inhalation,HFNC has a reduced reintubation rate and ICU length of stay;compared with non-invasive positive pressure ventilation（NPPV）,it has better comfort and compliance^[3],so it is more and more widely used in clinical practice.Objective:To explore whether nasal high-flow oxygen therapy and NPPV have similar efficacy in preventing weaning extubation and reintubation,so as to provide a new treatment for weaning extubation patients in ICU.Methods:Patients who underwent mechanical ventilation and met the weaning extubation criteria in the ICU of Jilin Provincial People’s Hospital from October 2019 to January 2021 were selected and divided into nasal high-flow oxygen therapy group（HFNC group）and NPPV group by random number method.A total of 85 patients met the weaning extubation criteria and passed the spontaneous breathing test,excluding patients who could not be weaned for various reasons,and finally a total of 66 patients,including 34 patients in the HFNC group and 32 patients in the NPPV group.On the basis of routine symptomatic and supportive treatment,HFNC group was given nasal high-flow oxygen therapy and NPPV group was given NPPV.The general data of patients at extubation were recorded.The changes of vital signs,blood gas analysis,comfort,sputum suction times,ICU length of stay,reintubation rate,incidence rate of complications,and 28-day mortality were compared between the two groups at 1 h,6 h,and 12 h after extubation.The differences in each clinical index between the two groups were observed and compared,so as to provide the basis for the selection of appropriate oxygen therapy for weaning extubation patients in the ICU.Results:1.There was no significant difference in the general data,heart rate,respiratory rate,oxygenation index,ventilation time,PH,blood lactate,mean arterial pressure and APACHEII score before extubation between the two groups（P>0.05）;2.There was a time effect on PaO₂/FiO₂,PaCO₂,RR and HR at 1h,6h and 12h after extubation in the two groups,that is,the above indicators were improved with time,but the effect of reducing RR and HR in the HFNC group was stronger than that in the NIPPV group,and the difference was statistically significant（P<0.05）.There was no significant difference in Pa O2/Fi O2 and Pa CO2 between the two groups（P>0.05）.3.There was no time effect on PH,Lac and MAP before and after treatment in both groups,and there was no significant difference between the two groups（P>0.05）.4.At 12h after treatment,the number of sputum suction,comfort score and incidence rate of complications in the two groups were lower in the HFNC group than in the NIPPV group,The difference had statistical significance（P<0.05）;5.There was no statistical significance in ICU length of stay,28-day mortality and reintubation indicators between the two groups（P>0.05）.Conclusion:1.HFNC and NIPPV can improve the symptoms of hypoxia in ICU patients with weaning extubation,can be used as a transitional treatment for ICU patients with extubation failure,for patients with respiratory failure（PaO₂/FiO₂>100 mm Hg）has a similar therapeutic effect.2.For ICU weaning and extubation patients,the two oxygen therapy methods have similar efficacy in terms of clinical prognosis,but HFNC has the advantages of better comfort,tolerance and compliance,with fewer complications,and is a good alternative when NIPPV has contraindications or patients cannot tolerate NPPV.