Application Of High-Flow Nasal Cannula Oxygen Therapy After Tracheal Extubation In Patiens With Cardiac Valve Surgery

Objective:Compared the application value of High-flow nasal cannula（HFNC）and Conventional oxygen therapy（COT）in oxygen therapy after extubation of cardiac valve surgery.To explore whether HFNC oxygen therapy can improve the oxygenation index,respiratory index and oxygen therapy comfort of patients,reduce the rate of reintubation,shorten the length patients’Intensive Care Unit（ICU）stay,reduce the mortality caused by pulmonary complications during hospitalization,and accelerate patients’postoperative recovery.Methods:Patients with cardiac valve surgery（including valve replacement and valve plasty）admitted to ICU of the First Affiliated Hospital of Wannan Medical College from March 2021 to September 2022 and with endotracheal intubation ventilator assisted ventilation when admitted to ICU were selected as the research objects.After inclusion,the patients were randomly divided into HFNC group or COT group by random number table method.（excel was used to generate a group of 1-60 random numbers,and the generated random numbers were sealed in an opaque carton in order for special care.When patients who met the criteria were enrolled,the carton was removed in accordance with the order of placement and handed over to the respiratory therapist in charge of implementation.The odd numbers were divided into the HFNC group,and the even numbers were divided into the COT group）After admission to ICU,patients were given conventional analgesics and other drugs.When the patient had no sedative drugs,high-dose vasoactive drugs and recovered consciousness through the SBT test,the tracheal intubation was removed,and then two different oxygen therapy methods were performed sequentially.Record the basic data of the two groups,comparing heart rate（HR）,respiratory rate（RR）,oxygenation index（OI）,Partial Pressure of Carbon Dioxide（Pa CO₂）,Alveolar-arteral oxygen difference（A-a DO₂）,Lactic acid（Lac）,Lung ultrasound score,comfort,whether reintubation occurred,length of ICU stay and mortality during hospitalisation.Results:There were no significant differences in gender,age,ASA classification,body mass index（BMI）and basic vital signs blood gas results between the HFNC group and COT group before extubation（P>0.05）.Before extubation,After 4 hours and 12 hours treatment,the OI values of the HFNC group and the COT group were 244.43±26.02mm Hg,308.40±63.75mm Hg,350.47±78.60mm Hg and 251.97±30.60mm Hg,273.27±51.97mm Hg,276.73±63.90mm Hg,respectively;RR were 23.03±1.40bpm,20.97±2.36bpm,19.13±2.97bpm and 23.03±1.67bpm,22.57±2.25bpm,22.40±3.06bpm,respectively;HR were 103.37±8.70bpm,92.07±12.75bpm,85.10±12.45bpm and 99.00±10.00bpm,95.97±11.05bpm,96.33±14.59bpm,respectively;Pa CO₂were 41.82±5.43mm Hg,39.28±4.73mm Hg,38.85±6.79mm Hg and 41.62±4.95mm Hg,40.96±4.58mm Hg,39.87±4.63mm Hg,respectively;A-a DO2 were 167.73±36.19mm Hg,129.21±39.00mm Hg,106.89±45.27mm Hg and 140.84±29.24mm Hg,123.64±29.42mm Hg,124.88±44.92mm Hg,respectively.Lac were 2.92±1.87,3.45±2.12,2.42±1.28 and 3.26±1.99,3.25±1.96,2.56±2.12;The median change of LUS score in HFNC group and COT group was 3.00 and1.50,respectively.The reintubation rates of HFNC group and COT group were 3.33%and13.33%,respectively.The median comfort scores of the HFNC group and COT group were2.00 and 4.00,respectively.The median length of ICU stay was 3.00 days and 4.50 days,respectively.There were significant differences in oxygenation index,respiratory rate and LUS score between the HFNC group and COT group after extubation（P<0.05）.The HFNC group was better than COT group in improving oxygenation,reducing respiratory rate and lung recruitment.The HR,Pa CO₂,A-a DO₂and Lac in HFNC group and COT group decreased,but there was no statistical significance.The HFNC group can significantly improve the comfort of patients after extubation,but there are no significant differences in the rate of reintubation after extubation,the length of stay in ICU and the mortality due to pulmonary complications during hospitalization between the two groups.Conclusion:High-flow nasal cannula oxygen therapy after extubation for heart valve surgery was superior to Conventional oxygen therapy,with a significant increase in oxygen index,smoother respiratory rate,lower atelectasis score and higher comfort in patients with atelectasis,but no significant changes in heart rate,alveolar arterial oxygen partial pressure difference,Lactic acid,partial pressure of carbon dioxide,reintubation rate,length of stay in the ICU and mortality due to pulmonary complications.Without considering the economic benefits,we may prefer High-flow nasal cannula as a continuation of oxygen therapy after extubation for heart valve surgery.