The Short Term Effect of Different Oxygen Therapies in Non-surgical Critically Ill Patients after Extubation

doi:10.12114/j.issn.1007-9572.2018.00.291

Abstract

Abstract: Backgroud　Heated humidified high flow nasal cannula（HFNC）is a safe，efficient and comfortable new oxygen therapy method，which has been applied widely in the field of respiratory therapy. However，the optimal population for HFNC is still unclear. Objective　To investigate the short term effect of HFNC and conventional oxygen therapy （COT） applied to non-surgical critically ill patients after extubation in ICU.Methods　A prospective analysis of 87 patients with endotracheal intubation admitted to the Department of Critical Care Medicine，Cixi Hospital Affiliated to Wenzhou Medical University from September 2016 to February 2018 was performed.Patients who were ready for planned extubation were randomized （random number） to receive HFNC（HFNC group） or COT（COT group） sequentially after extubation.Oxygenation index （PaO2/FiO2），arterial partial pressure of carbon dioxide （PaCO2），respiratory rate and heart rate were compared between two groups 24 hours after extubation.The main observation result was re-intubation rate within 48 hours after extubation.Secondary observations included duration of ICU stay，duration of hospitalization，and in-hospital mortality.Results　A total of 82 patients who met the inclusion criteria were enrolled in the study，with 42 cases in HFNC group and 40 cases in COT group.The oxygenation index of HFNC group was higher than that of COT group 24 hours after extubation，and the respiration rate and heart rate of HFNC group were lower than those of COT group 24 hours after extubation（P<0.05），but there was no significant difference of PaCO2 between two groups（P>0.05）．The re-intubation rate 48 hours after extubation，duration of ICU stay and duration of hospitalization in HFNC group were significantly lower than those in COT group（P<0.05），but there was no significant difference of in-hospital mortality between two groups（P>0.05）．Conclusion　Compared to COT，HFNC sequentially applied to non-surgical critically ill patients has an advantage in term of oxygenation index after extubation.Furthermore，HFNC can reduce re-intubation rate 48 hours after extubation，duration of ICU stay and duration of hospitalization .Therefore，HFNC could be used as a preferred treatment in non-surgical critically ill patients after extubation in ICU.

Key words: Oxygen therapy, Airway extubation, Nasal high flow oxygen therapy, Oxygenation index, Re-intubation rate

摘要： 背景　经鼻高流量氧气湿化治疗（HFNC）是一种安全、高效、舒适的新型氧疗方式，在呼吸治疗领域已得到越来越多的应用。但关于HFNC氧疗的最佳适宜人群仍不明确。目的　探讨重症医学科（ICU）非手术危重患者气管插管拔管后接受HFNC与常规氧疗（COT）的短期疗效。方法　前瞻性分析2016年9月—2018年2月温州医科大学附属慈溪医院ICU收治的患者87例，在符合常规脱机拔管程序基础上，采用随机数字法将患者分为HFNC组和COT组，分别予拔管后序贯HFNC和COT。比较两组患者拔管后24 h氧合指数（PaO2/FiO2）、动脉血二氧化碳分压（PaCO2）、呼吸频率及心率，主要观察结果为拔管后48 h再插管率，次要观察结果包括ICU住院时间、总住院时间及住院病死率。结果　87例患者中2例患者在拔管后因急诊手术需要行再次插管，3例患者拔管后需紧急气管插管，故予剔除。最终纳入82例，其中HFNC组42例，COT组40例。HFNC组拔管后24 h PaO2/FiO2高于COT组，呼吸频率、心率低于COT组（P<0.05）；两组PaCO2比较，差异无统计学意义（P>0.05）。HFNC组拔管后48 h再插管率低于COT组，ICU住院时间和总住院时间短于COT组（P<0.05）；两组住院病死率比较，差异无统计学意义（P>0.05）。结论　相比于COT，拔管后序贯HFNC更能改善ICU非手术危重患者的PaO2/FiO2，且可以降低拔管后48 h再插管率、ICU住院时间及总住院时间，故HFNC可作为ICU非手术危重患者气管插管拔管后的首选氧疗方案。

关键词: 氧疗, 气管插管拔除, 经鼻高流量氧疗, 氧合指数, 再插管率

SUN Bo,ZHANG Tianqing,HU Xuezhong, et al. The Short Term Effect of Different Oxygen Therapies in Non-surgical Critically Ill Patients after Extubation　[J]. Chinese General Practice, 2019, 22(17): 2121-2124. DOI: 10.12114/j.issn.1007-9572.2018.00.291.
孙波,张天卿,胡雪忠等. 非手术危重患者气管插管拔管后不同氧疗方式的短期疗效比较分析[J]. 中国全科医学, 2019, 22(17): 2121-2124. DOI: 10.12114/j.issn.1007-9572.2018.00.291.

References

［1］FRAT J P，THILLE A W，MERCAT A，et al．High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure［J］．N Engl J Med，2015，372（23）：2185-2196．DOI：10.1056/NEJMoa1503326.
［2］NEDEL W L，DEUTSCHENDORF C，MORAES RODRIGUES FILHO E.High-flow nasal cannula in criticallyⅢ subjects with or at risk for respiratory failure：a systematic review and meta-analysis［J］．Respir Care，2017，62（1）：123-132．DOI：10.4187/respcare.04831.
［3］STEPHAN F，BARRUCAND B，PETIT P，et al．High-flow nasal oxygen vs noninvasive positive airway pressure in hypoxemic patients after cardiothoracic surgery：a randomized clinical trial［J］．JAMA，2015，313（23）：2331-2339．DOI：10.1001/jama.2015.5213.
［4］ROCA O，HERNANDEZ G，DíAZ-LOBATO S，et al．Current evidence for the effectiveness of heated and humidified high flow nasal cannula supportive therapy in adult patients with respiratory failure［J］．Crit Care，2016，20（1）：109．DOI：10.1186/s13054-016-1263-z.
［5］GAUNT K A，SPILMAN S K，HALUB M E，et al．High-flow nasal cannula in a mixed adult ICU［J］．Respir Care，2015，60（10）：1383-1389．DOI：10.4187/respcare.04016.
［6］HERNANDEZ G，ROCA O，COLINAS L.High-flow nasal cannula support therapy：new insights and improving performance［J］．Crit Care，2017，21（1）：62．DOI：10.1186/s13054-017-1640-2.
［7］HERNANDEZ G，VAQUERO C，GONZALEZ P，et al．Effect of postextubation high-flow nasal cannula vs conventional oxygen therapy on reintubation in low-risk patients：a randomized clinical trial［J］．JAMA，2016，315（13）：1354-1361．DOI：10.1001/jama.2016.2711.
［8］FUTIER E，PAUGAM-BURTZ C，GODET T，et al．Effect of early postextubation high-flow nasal cannula vs conventional oxygen therapy on hypoxaemia in patients after major abdominal surgery：a French multicentre randomised controlled trial（OPERA）［J］．Intensive Care Med，2016，42（12）：1888-1898．DOI：10.1007/s00134-016-4594-y.
［9］EPSTEIN S K，CIUBOTARU R L，WONG J B.Effect of failed extubation on the outcome of mechanical ventilation［J］．Chest，1997，112（1）：186-192.
［10］ESTEBAN A，ALIA I，GORDO F，et al．Extubation outcome after spontaneous breathing trials with T-tube or pressure support ventilation.The Spanish Lung Failure Collaborative Group［J］．Am J Respir Crit Care Med，1997，156（2 Pt 1）：459-465．DOI：10.1164/ajrccm.156.2.9610109.
［11］EPSTEIN S K，CIUBOTARU R L.Independent effects of etiology of failure and time to reintubation on outcome for patients failing extubation［J］．Am J Respir Crit Care Med，1998，158（2）：489-493．DOI：10.1164/ajrccm.158.2.9711045.
［12］THILLE A W，HARROIS A，SCHORTGEN F，et al．Outcomes of extubation failure in medical intensive care unit patients［J］．Crit Care Med，2011，39（12）：2612-2618.
［13］FRUTOS-VIVAR F，ESTEBAN A，APEZTEGUIA C，et al．Outcome of reintubated patients after scheduled extubation［J］．J Crit Care，2011，26（5）：502-509．DOI：10.1016/j.jcrc.2010.12.015.
［14］DYSART K，MILLER T L，WOLFSON M R，et al．Research in high flow therapy：mechanisms of action［J］．Respir Med，2009，103（10）：1400-1405．DOI：10.1016/j.rmed.2009.04.007.
［15］PARKE R L，ECCLESTON M L，MCGUINNESS S P.The effects of flow on airway pressure during nasal high-flow oxygen therapy［J］．Respir Care，2011，56（8）：1151-1155.
［16］MAGGIORE S M，IDONE F A，VASCHETTO R，et al．Nasal high-flow vs venturi mask oxygen therapy after extubation：effects on oxygenation，comfort and clinical outcome［J］．Am J Respir Crit Care Med，2014，190（3）：282-288．DOI：10.1164/rccm.201402-0364OC.
［17］卢骁，高玉芝，吴春双，等．经鼻高流量氧疗在基于肺超声评估的高风险脱机患者中的应用［J］．中华急诊医学杂志，2018，27（4）：367-372．DOI：10.3760/cma.j.issn.1671-0282.2018.04.006.
LU X，GAO Y Z，WU C S，et al．The role of high-flow oxygen insufflation via nasal cannula in patients at high risk of re-intubation after weaning from mechanical ventilation assessed by lung ultrasound score［J］．Chinese Journal of Emergency Medicine，2018，27（4）：367-372．DOI：10.3760/cma.j.issn.1671-0282.2018.04.006.
［18］NISHIMURA M.High-flow nasal cannula oxygen therapy in adults：physiological benefits，indication，clinical benefits，and adverse effects［J］．Respir Care，2016，61（4）：529-541．DOI：10.4187/respcare.04577.
［19］FRAT J P，BRUGIERE B，RAGOT S，et al．Sequential application of oxygen therapy via high-flow nasal cannula and noninvasive ventilation in acute respiratory failure：an observational pilot study［J］．Respir Care，2015，60（2）：170-178．DOI：10.4187/respcare.03075.
［20］KANG B J，KOH Y，LIM C M，et al．Failure of high-flow nasal cannula therapy may delay intubation and increase mortality［J］．Intensive Care Med，2015，41（4）：623-632．DOI：10.1007/s00134-015-3693-5.

[1]	HE Yueyue, LIU Huan, TIAN Yongming, DU Aiping, XU Yu, JING Wenwen. New Advances in Post-tracheal Extubation Swallowing Dysfunction in Critically Ill Patients [J]. Chinese General Practice, 2022, 25(06): 760-765.
[2]	WANG Jun，JIANG Shuqing. Evaluation of Prognosis of Novel Coronavirus Pneumonia Combined with Acute Respiratory Distress Syndrome Patients with the Oxygenation Index and Dispersion Index of Mechanical Ventilation　 [J]. Chinese General Practice, 2021, 24(35): 4481-4484.
[3]	LI Gen，RONG Ling，ZHAO Meijing，SUN Jie. Effect of Optimal Positive End-expiratory Pressure Guided by Bedside Ultrasound on Oxygenation Index and Hemodynamics in Patients with Acute Respiratory Distress Syndrome [J]. Chinese General Practice, 2019, 22(5): 616-620.
[4]	WU Yuejiao，YANG Shumei，CHEN Ruilin. Research Progress on Clinical Application of Humidified High Flow Oxygen Therapy　 [J]. Chinese General Practice, 2019, 22(18): 2253-2257.