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.

经鼻高流量湿化氧疗联合早期肠内营养在AECOPD合并呼吸衰竭患者中的应用

目的探讨经鼻高流量湿化氧疗联合早期肠内营养在慢性阻塞性肺疾病急性加重(AECOPD)合并呼吸衰竭患者中的应用效果。方法选取2019年10月—2021年10月郑州大学第一附属医院收治的70例AECOPD合并呼吸衰竭患者,采用随机数字表法分为联合组与对照组,每组35例。2组患者均给予经鼻高流量湿化氧疗治疗,联合组患者在此基础上联用肠内营养干预。比较2组患者的治疗效果、住院时间及治疗前后血气指标、炎症指标、营养指标、痰液黏稠度。结果2组患者治疗2周后血氧分压(Pa O_(2))、氧合指数(Pa O_(2)/Fi O_(2))水平均高于治疗前且联合组高于对照组,血二氧化碳分压(Pa CO_(2))水平均低于治疗前且联合组低于对照组,差异均有统计学意义(P<0.05)。2组患者治疗2周后超敏C反应蛋白(hs-CRP)、降钙素原(PCT)、乳酸(LA)水平均低于治疗前,且联合组低于对照组,差异均有统计学意义(P<0.05)。2组患者治疗2周后血清总蛋白(TP)、白蛋白(ALB)、前白蛋白(PA)、血红蛋白(Hb)水平均高于治疗前,且联合组高于对照组,差异均有统计学意义(P<0.05)。2组患者治疗前痰液黏稠度分级比较,差异无统计学意义(Z=0.579,P=0.144);联合组患者治疗2周后痰液黏稠度分级低于对照组,差异有统计学意义(Z=3.077,P=0.007)。联合组患者治疗有效率为88.57%,高于对照组的68.57%,差异有统计学意义(χ^(2)=4.158,P=0.041);联合组患者住院时间为(18.79±3.53)d,短于对照组的(22.91±6.05)d,差异有统计学意义(t=3.480,P<0.05)。结论经鼻高流量湿化氧疗联合早期肠内营养治疗AECOPD合并呼吸衰竭的疗效较好,能够有效改善患者血气指标、炎症指标及营养指标水平,降低痰液黏稠度,缩短住院时间。

不同湿度经鼻高流量吸氧对AECOPD合并呼吸衰竭患者治疗效果对比

目的对比不同湿度经鼻高流量吸氧(HFNC)对慢性阻塞性肺疾病急性加重期合并呼吸衰竭患者治疗效果。方法选择2018年6月至2019年12月在我院接受治疗的AECOPD合并呼吸衰竭患者96例,采用随机数字表法将患者分为三组,各32例。所有患者均在常规治疗基础上给与HFNC治疗,三组温度均控制在31℃~37℃,相对湿度A组控制在<60%,B组61%~80%,C组81%~100%。比较三组患者临床疗效、呼吸功能、血气分析指标、吸氧舒适度及依从性。结果B组总有效率93.75%,高于A组71.88%及C组68.75%,差异有统计学意义(P<0.05)。治疗前三组mMRC评分及CAT评分差异无统计学意义(P>0.05),治疗后三组患者mMRC评分及CAT评分均低于治疗前,且B组mMRC评分及CAT评分均低于A组及C组,差异有统计学意义(P<0.05)。治疗前三组患者pH、氧分压及二氧化碳分压差异无统计学意义(P>0.05),治疗后三组pH及氧分压均明显升高,但B组治疗后pH及氧分压均高于A组与C组,治疗后三组二氧化碳分压均明显下降,但B组治疗后二氧化碳分压低于A组与C组,差异有统计学意义(P<0.05)。B组舒适度评分及总依从率均高于A组及C组(P<0.05),A组与C组比较差异无统计学意义(P>0.05)。结论当温度在31℃~37℃时,HFNC相对湿度控制在61%~80%可提高AECOPD合并呼吸衰竭患者疗效,改善患者呼吸功能、血气分析指标,并可提高吸氧舒适度及依从性。

经鼻高流量氧疗在不同原因呼吸衰竭患者中的临床疗效分析

目的探讨经鼻高流量氧疗(HFNC)在不同原因呼吸衰竭患者的临床应用效果。方法回顾性分析2016年5月—2017年11月期间广州市第八人民医院综合ICU收治34例接受HFNC的不同原因呼吸衰竭患者病例资料。根据HFNC治疗是否有效将其分为有效组和无效组,比较两组患者的血气结果及临床指标等。结果 HFNC治疗有效率为82.35%。无效组使用HFNC前APACHⅡ评分为(21.00±3.52)分,大于有效组的(15.29±5.62)分;无效组RR值为(33.17±6.74)次/min,大于有效组(24.93±6.39)次/min;有效组MAP为(88.89±10.97)mm Hg,大于无效组(73.83±9.04)mm Hg;有效组氧合指数(OI)(224.32±58.60),大于无效组OI(163.13±49.22),差异均有统计学意义(P<0.05)。HFNC有效组肺泡动脉氧分压差(A-aDO2)、心率、呼吸在HFNC治疗后明显改善,差异有统计学意义(P<0.05)。结论 HFNC可作为轻中度ARDS、心功能不全所致低氧血症患者的一线呼吸支持治疗手段。

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.

经鼻高流量湿化氧疗用于气管切开患者的基础研究及改进

目的评估经鼻高流量湿化氧疗(HFNC)及人工气道连接管加延长管用于气管切开患者时不同流量、潮气量对进入至隆突部位气体的温度、湿度及氧浓度的影响,寻找一种更加有效的用于气管切开患者的HFNC方式。方法建立HFNC模型,测定不同流量及潮气量组合下气管内温度、湿度及氧浓度的变化,观察潮气量及流量对气管内温度、湿度及氧浓度的影响;测定人工气道连接管加延长管后不同流量及潮气量组合下气管内温度、湿度及氧浓度的变化,观察延长管对气管内温度、湿度及氧浓度的影响。结果同等潮气量前提下,流量越大,到达隆突部位气体的温度越高,湿度越大,氧浓度越高;同等流量前提下,潮气量越大,到达隆突部位的温度越低,湿度越小,氧浓度越低。人工气道连接管加延长管后同等流量及潮气量前提下,可提高到达隆突部位气体的温度、湿度及氧浓度。结论HFNC用于气管切开患者时进入隆突部位的气体温度、湿度及氧浓度受潮气量、流量的影响;人工气道连接管加延长管后可提高HFNC效率。