Analysis of the Efficacy of Humidified High-Flow Nasal Oxygen Therapy Combined with Alveolar Lavage in the Treatment of Patients with Severe Pneumonia Complicated with Respiratory Failure

Objective:To analyze the curative effect of humidified high-flow nasal oxygen therapy combined with alveolar lavage in patients with severe pneumonia and respiratory failure.Methods:120 patients with severe pneumonia complicated with respiratory failure admitted to the Third People’s Hospital of Xining from July 2021 to December 2022 were randomly divided into two groups:group A and group B.The patients in group A were given humidified high-flow nasal oxygen therapy combined with alveolar lavage,whereas those in group B were given humidified high-flow nasal oxygen therapy.The treatment efficacy,blood gas analysis results,and differences in inflammatory mediators were compared between the two groups.Results:The curative effect in group A(96.67%)was significantly higher than that in group B(81.67%),P<0.05;the partial pressure of carbon dioxide(PaCO2),partial pressure of oxygen(PaO2),oxygen saturation(SpO2),and Horowitz index(P/F)of group A were significantly better than group B,P<0.05;the interleukin 6(IL-6),tumor necrosis factor alpha(TNF-α),and C-reactive protein(CRP)levels,white blood cell(WBC)count,serum procalcitonin(PCT),and neutrophil(N)percentage of group A were significantly lower than those of group B,P<0.05.Conclusion:For patients with severe pneumonia complicated with respiratory failure,alveolar lavage,on the basis of humidified high-flow oxygen therapy,can inhibit local inflammation,improve blood gas analysis results,promote disease recovery,and improve the clinical treatment effect。

Sleep Quality for Patients Receiving Noninvasive Positive Pressure Ventilation and Nasal High-Flow Oxygen Therapy in an ICU: Two Case Studies

Aim: The purpose of this case study was to examine the sleep quality of patients receiving noninvasive positive pressure ventilation (NPPV) or nasal high-flow oxygen therapy (NHF) in an intensive care unit and to investigate what types of nursing support are offered to such patients. Methods: We examined one patient each for NPPV and NHF. Polysomnography (PSG), review of the patient charts, and semi-structured interviews were used to collect the data for analysis. Results: Patients treated with NPPV or NHF demonstrated a noticeable reduction in deep sleep, with most of their sleep being shallow. Their sleep patterns varied greatly from those of healthy individuals. These results suggest that, in addition to experiencing extremely fragmented sleep, sleep in these patients was more likely to be interrupted by nursing interventions, such as during auscultation of breath sounds. Furthermore, it was revealed that “anxiety or discomfort that accompanies the mask or air pressure” in patients treated with NPPV and “discomfort that accompanies the nasal cannula or NHF circuit” in patients treated with NHF may be primary causes of disrupted sleep. Our results suggest a need for nursing care aimed at improving sleep quality in patients treated with NPPV or NHF.

Efficacy of high-flow nasal cannula on acute exacerbation of chronic obstructive pulmonary disease: A meta-analysis

Objective:To systematically evaluate the efficacy and feasibility of high-flow nasal cannula(HFNC)on patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods:Systematic searches on PubMed,Web of Science,the Cochrane Library,Embase,CBM(Chinese Biomedicine Database),CNKI(China National Knowledge Infrastructure),Wanfang Database and VIP were performed for randomized controlled trials(RCTs)which explored the effects of HFNC on patients with AECOPD.The retrieval time was from the establishment of each database to July 2019.RevMan5.3 software was used for statistical analysis.Results:A total of 12 articles were included,involving 812 patients.The results showed that:(1)Compared with conventional oxygen therapy,HFNC could improve patients'arterial partial oxygen pressure(PaO2)(MD=12.70,95%CI(7.00,18.40),Z=4.37,P<0.0001),reduce partial arterial blood carbon dioxide(PaCO2)(MD=-10.99,95%CI(-14.42,-7.55),Z=6.26,P<0.00001)and reduce endotracheal intubation rate(OR=0.19,95%CI(0.04,0.93),Z=2.05,P=0.04),shorten the hospitalization time(SMD=-0.74,95%CI(-1.11,-0.37),Z=3.95,P<0.0001).(2)Compared with non-invasive positive pressure ventilation,it has fewer adverse reactions(OR=0.18,95%CI(0.09,0.35),Z=5.08,P<0.00001)and shorter hospital stay(SMD=-0.57,95%CI(-0.90,-0.23),Z=3.33,P=0.0009).Conclusion:HFNC can improve the patients’hypoxia symptoms and CO2 retention,reduce the rate of tracheal intubation,and alleviate adverse reactions.However,Limited by the quality and region of the included studies,more high-quality are needed to test it.

自制简易单腔高流量鼻导管在留置鼻胃管患者经鼻高流量湿化氧疗中的应用

目的:探讨自制简易单腔高流量鼻导管在留置鼻胃管患者经鼻高流量湿化氧疗(HFNC)中的应用效果。方法:选取2022年1—10月河南科技大学附属黄河三门峡医院收治的使用HFNC的留置鼻胃管患者58例为观察对象,根据随机数字表法分为对照组和观察组,各29例。对照组使用双腔高流量鼻导管进行湿化氧疗,观察组使用自制简易单腔高流量鼻导管进行湿化氧疗。比较两组患者高流量鼻导管脱出次数、护理人员重复固定高流量鼻导管的工作量及高流量鼻导管固定部位医疗器械相关压力性损伤发生率。结果:观察组鼻导管平均每天脱出1次、2~3次及>3次的占比低于对照组,差异有统计学意义(P<0.05);观察组重复固定高流量鼻导管所耗的时间短于对照组,更换胶布次数、胶布使用数量均少于对照组,差异有统计学意义(P<0.001);观察组高流量鼻导管固定部位医疗器械相关压力性损伤发生率低于对照组,差异有统计学意义(P=0.021)。结论:应用自制简易单腔高流量鼻导管为留置鼻胃管患者进行HFNC,可有效降低鼻导管脱出次数,维持患者氧疗的稳定性,减少护理人员重复固定的工作量,降低鼻导管固定部位医疗器械相关压力性损伤发生率。

加温加湿经鼻高流量氧疗仪对AECOPD患者舒适度的影响

目的:探究加温加湿经鼻高流量氧疗仪对AECOPD患者舒适度的影响。方法:120例AECOPD患者随机分为对照组和观察组,对照组予以无创机械通气治疗,观察组予以加温加湿经鼻高流量氧疗仪治疗,比较两组患者肺功能、血气分析指标、舒适度评分、住院时间、ICU时间、并发症及结局归转。结果:治疗后观察组肺功能指标、血氧分压、氧合指数、舒适度评分均显著高于对照组(P<0.05);治疗后观察组住院时间、ICU时间均明显低于对照组(P<0.05)。结论:加温加湿经鼻高流量氧疗仪可提高AECOPD患者舒适度,改善其肺功能及血气分析指数。

Oxygenation strategies after extubation of critically ill and postoperative patients

In intensive care units(ICUs),the decision to extubate is a critical one because mortality is particularly high in case of reintubation.Around 15%of patients ready to be weaned offa ventilator experience extubation failure leading to reintubation.The use of high-flow nasal oxygen and non-invasive ventilation are two alternatives of standard oxygen supplementation that may help to prevent reintubation.High-flow nasal oxygen and non-invasive ventilation,may be used to prevent reintubation in patients with low(e.g.,patients without comorbidities and with short durations of mechanical ventilation)and high risk(e.g.,patients>65 years and those with underlying cardiac disease,chronic respiratory disorders,and/or hypercapnia at the time of extubation)of reintubation,respectively.However,non-invasive ventilation used as a rescue therapy to treat established post-extubation respiratory failure could increase mortality by delaying reintubation,and should therefore be used very carefully in this setting.The oxygenation strategy to be applied in postoperative patients is different from the patients who are extubated in the ICUs.Standard oxygen after a surgical procedure is adequate,even following major abdominal or cardio-thoracic surgery,but should probably be switched to high-flow nasal oxygen in patients with hypoxemic.Unlike in patients experiencing post-extubation respiratory failure in ICUs wherein non-invasive ventilation may have deleterious effects,it may actually improve the outcomes in postoperative patients with respiratory failure.This review discusses the different clinical situations with the aim of choosing the most effective oxygenation strategy to prevent post-extubation respiratory failure and to avoid reintubation.