BACKGROUND: We sought to demonstrate the superiority of a targeted therapy strategy involving high-flow nasal cannula oxygen(HFNCO_(2)) therapy and noninvasive ventilation(NIV) using lung ultrasound score(LUS) in comp...BACKGROUND: We sought to demonstrate the superiority of a targeted therapy strategy involving high-flow nasal cannula oxygen(HFNCO_(2)) therapy and noninvasive ventilation(NIV) using lung ultrasound score(LUS) in comparison with standard care among patients in the intensive care unit(ICU) who undergo successful weaning to decrease the incidence of extubation failure at both 48 hours and seven days.METHODS: During the study period, 98 patients were enrolled in the study, including 49 in the control group and 49 in the treatment group. Patients in the control group and patients with an LUS score <14 points(at low risk of extubation failure) in the treatment group were extubated and received standard preventive care without NIV or HFNCO_(2). Patients with an LUS score ≥14 points(at high risk of extubation failure) in the treatment group were extubated with a second review of the therapeutic optimization to identify and address any persisting risk factors for postextubation respiratory distress;patients received HFNCO2 therapy combined with sessions of preventive NIV(4-8 hours per day for 4-8 sessions total) for the first 48 hours after extubation.RESULTS: In the control group, 13 patients had the LUS scores ≥14 points, while 36 patients had scores <14 points. In the treatment group, 16 patients had the LUS scores ≥14 points, while 33 patients had scores <14 points. Among patients with the LUS score ≥14 points, the extubation failure rate within 48 hours was 30.8% in the control group and 12.5% in the treatment group, constituting a statistically significant difference(P<0.05). Conversely, among patients with an LUS score <14 points, 13.9% in the control group and 9.1% in the treatment group experienced extubation failure(P=0.61). The length of ICU stay(9.4±3.1 days vs. 7.2±2.4 days) was significantly different and the re-intubation rate(at 48 hours: 18.4% vs. 10.2%;seven days: 22.4% vs. 12.2%) significantly varied between the two groups(P<0.05). There was no significant difference in the 28-day mortality rate(6.1% vs. 8.2%) between the control and treatment groups.CONCLUSIONS: Among high-risk adults being weaned from mechanical ventilation and assessed by LUS, the NIV+HFNCO_(2) protocol does not lessen the mortality rate but reduce the length of ICU stay, the rate of extubation failure at both 48 hours and seven days.展开更多
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 Pub...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.展开更多
目的探讨以肺部感染控制窗(PIC)为有创-无创序贯通气切换指征的经鼻高流量湿化氧疗(HFNC)或无创正压通气(NIPPV)治疗对慢性阻塞性肺疾病急性加重期(AECOPD)患者氧合指数(PaO_(2)/FiO_(2))、动态肺顺应性(Cdyn)的影响。方法我院收治的AEC...目的探讨以肺部感染控制窗(PIC)为有创-无创序贯通气切换指征的经鼻高流量湿化氧疗(HFNC)或无创正压通气(NIPPV)治疗对慢性阻塞性肺疾病急性加重期(AECOPD)患者氧合指数(PaO_(2)/FiO_(2))、动态肺顺应性(Cdyn)的影响。方法我院收治的AECOPD患者134例,其中70例采取有创机械通气+HFNC(HFNC组),64例采取有创机械通气+NIPPV(NIPPV组),均根据出现PIC窗作为有创-无创序贯通气切换点。比较两组有创机械通气前、后的动脉血氧分压(PaO_(2))、二氧化碳分压(PaCO_(2))、血氧饱和度(SaO_(2)),拔管前、后的PaO_(2)/FiO_(2)与Cdyn,以及并发症发生率。结果两组有创机械通气前、后PaO_(2)、PaCO_(2)、SaO_(2)比较差异无统计学意义(P>0.05)。拔管后12、24、48 h HFNC组PaO_(2)/FiO_(2)与Cdyn均高于NIPPV组(P<0.05)。HFNC组吸痰、面部压力性损伤、误吸并发症发生率低于NIPPV组(P<0.05)。两组28 d再插管率比较差异无统计学意义(P>0.05)。结论以PIC为有创-无创序贯通气切换指征,HFNC更能有效改善氧合,提高肺顺应性,改善呼吸功能,减少并发症,可替代传统NIPPV。展开更多
目的分析有创机械通气脱机后序贯经鼻高流量氧疗(HFNC)的特点及治疗失败的危险因素.方法选择2016年6月1日至2018年5月31日北京大学人民医院外科重症医学科(ICU)有创机械通气脱机后序贯HFNC治疗的患者.收集患者一般临床资料、呼吸治疗相...目的分析有创机械通气脱机后序贯经鼻高流量氧疗(HFNC)的特点及治疗失败的危险因素.方法选择2016年6月1日至2018年5月31日北京大学人民医院外科重症医学科(ICU)有创机械通气脱机后序贯HFNC治疗的患者.收集患者一般临床资料、呼吸治疗相关参数、呼吸生理相关指标、循环相关指标及结局指标,分析脱机后序贯HFNC的治疗特点.根据HFNC失败与否将患者分为HFNC失败组与HFNC成功组,比较两组各项指标的差异;采用多因素Logistic回归分析HFNC治疗失败的独立危险因素,并对各危险因素和回归模型预估值预测治疗失败的价值进行受试者工作特征曲线(ROC)分析.结果共纳入99例患者,男性61例,中位年龄67.0(57.0,76.0)岁.HFNC初始治疗流速为50(50,60)L/min,吸入氧浓度(FiO2)为0.50(0.40,0.60).有18例患者(18.2%)HFNC治疗失败.与HFNC成功组相比,HFNC失败组序贯器官衰竭评分(SOFA)更高〔分:4(3,5)比2(1,3),P<0.01〕,治疗前血B型利钠肽(BNP)水平更高〔ng/L:647.2(399.2,1 331.3)比127.2(55.2,369.5),P<0.01〕,HFNC治疗30 min呼吸频率(RR)和心率(HR)更快〔RR(次/min):26(22,28)比19(17,21),HR(次/min):105(97,107)比85(77,90),均P<0.01〕,平均动脉压(MAP)更高〔mmHg(1 mmHg=0.133 kPa):104.3(101.7,110.7)比92.3(88.3,97.7),P<0.01〕,氧合指数(PaO2/FiO2)更低〔mmHg:207.3(185.8,402.8)比320.2(226.2,361.5),P<0.05〕.多因素Logistic回归分析显示,SOFA评分〔优势比(OR)=2.818,P=0.022,β=1.036〕、治疗前BNP(OR=1.002,P=0.033,β=0.002)和治疗30 min HR(OR=1.140,P=0.032,β=0.131)为HFNC治疗失败的独立危险因素.ROC曲线分析显示,SOFA、治疗前BNP、治疗30 min HR和Logistic回归模型预估值预测HFNC失败的ROC曲线下面积(AUC)分别为0.840、0.859、0.860和0.962,均有较好的预测价值(均P<0.01).结论脱机后序贯HFNC治疗是ICU常用的氧疗手段之一,但并不是所有患者都能从中获益;SOFA评分、治疗前BNP和治疗30 min HR为外科ICU有创机械通气患者脱机后序贯HFNC治疗失败的独立危险因素,且各独立危险因素及回归模型均可预测HFNC治疗成功与否.展开更多
文摘BACKGROUND: We sought to demonstrate the superiority of a targeted therapy strategy involving high-flow nasal cannula oxygen(HFNCO_(2)) therapy and noninvasive ventilation(NIV) using lung ultrasound score(LUS) in comparison with standard care among patients in the intensive care unit(ICU) who undergo successful weaning to decrease the incidence of extubation failure at both 48 hours and seven days.METHODS: During the study period, 98 patients were enrolled in the study, including 49 in the control group and 49 in the treatment group. Patients in the control group and patients with an LUS score <14 points(at low risk of extubation failure) in the treatment group were extubated and received standard preventive care without NIV or HFNCO_(2). Patients with an LUS score ≥14 points(at high risk of extubation failure) in the treatment group were extubated with a second review of the therapeutic optimization to identify and address any persisting risk factors for postextubation respiratory distress;patients received HFNCO2 therapy combined with sessions of preventive NIV(4-8 hours per day for 4-8 sessions total) for the first 48 hours after extubation.RESULTS: In the control group, 13 patients had the LUS scores ≥14 points, while 36 patients had scores <14 points. In the treatment group, 16 patients had the LUS scores ≥14 points, while 33 patients had scores <14 points. Among patients with the LUS score ≥14 points, the extubation failure rate within 48 hours was 30.8% in the control group and 12.5% in the treatment group, constituting a statistically significant difference(P<0.05). Conversely, among patients with an LUS score <14 points, 13.9% in the control group and 9.1% in the treatment group experienced extubation failure(P=0.61). The length of ICU stay(9.4±3.1 days vs. 7.2±2.4 days) was significantly different and the re-intubation rate(at 48 hours: 18.4% vs. 10.2%;seven days: 22.4% vs. 12.2%) significantly varied between the two groups(P<0.05). There was no significant difference in the 28-day mortality rate(6.1% vs. 8.2%) between the control and treatment groups.CONCLUSIONS: Among high-risk adults being weaned from mechanical ventilation and assessed by LUS, the NIV+HFNCO_(2) protocol does not lessen the mortality rate but reduce the length of ICU stay, the rate of extubation failure at both 48 hours and seven days.
文摘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.
文摘目的探讨以肺部感染控制窗(PIC)为有创-无创序贯通气切换指征的经鼻高流量湿化氧疗(HFNC)或无创正压通气(NIPPV)治疗对慢性阻塞性肺疾病急性加重期(AECOPD)患者氧合指数(PaO_(2)/FiO_(2))、动态肺顺应性(Cdyn)的影响。方法我院收治的AECOPD患者134例,其中70例采取有创机械通气+HFNC(HFNC组),64例采取有创机械通气+NIPPV(NIPPV组),均根据出现PIC窗作为有创-无创序贯通气切换点。比较两组有创机械通气前、后的动脉血氧分压(PaO_(2))、二氧化碳分压(PaCO_(2))、血氧饱和度(SaO_(2)),拔管前、后的PaO_(2)/FiO_(2)与Cdyn,以及并发症发生率。结果两组有创机械通气前、后PaO_(2)、PaCO_(2)、SaO_(2)比较差异无统计学意义(P>0.05)。拔管后12、24、48 h HFNC组PaO_(2)/FiO_(2)与Cdyn均高于NIPPV组(P<0.05)。HFNC组吸痰、面部压力性损伤、误吸并发症发生率低于NIPPV组(P<0.05)。两组28 d再插管率比较差异无统计学意义(P>0.05)。结论以PIC为有创-无创序贯通气切换指征,HFNC更能有效改善氧合,提高肺顺应性,改善呼吸功能,减少并发症,可替代传统NIPPV。
文摘目的分析有创机械通气脱机后序贯经鼻高流量氧疗(HFNC)的特点及治疗失败的危险因素.方法选择2016年6月1日至2018年5月31日北京大学人民医院外科重症医学科(ICU)有创机械通气脱机后序贯HFNC治疗的患者.收集患者一般临床资料、呼吸治疗相关参数、呼吸生理相关指标、循环相关指标及结局指标,分析脱机后序贯HFNC的治疗特点.根据HFNC失败与否将患者分为HFNC失败组与HFNC成功组,比较两组各项指标的差异;采用多因素Logistic回归分析HFNC治疗失败的独立危险因素,并对各危险因素和回归模型预估值预测治疗失败的价值进行受试者工作特征曲线(ROC)分析.结果共纳入99例患者,男性61例,中位年龄67.0(57.0,76.0)岁.HFNC初始治疗流速为50(50,60)L/min,吸入氧浓度(FiO2)为0.50(0.40,0.60).有18例患者(18.2%)HFNC治疗失败.与HFNC成功组相比,HFNC失败组序贯器官衰竭评分(SOFA)更高〔分:4(3,5)比2(1,3),P<0.01〕,治疗前血B型利钠肽(BNP)水平更高〔ng/L:647.2(399.2,1 331.3)比127.2(55.2,369.5),P<0.01〕,HFNC治疗30 min呼吸频率(RR)和心率(HR)更快〔RR(次/min):26(22,28)比19(17,21),HR(次/min):105(97,107)比85(77,90),均P<0.01〕,平均动脉压(MAP)更高〔mmHg(1 mmHg=0.133 kPa):104.3(101.7,110.7)比92.3(88.3,97.7),P<0.01〕,氧合指数(PaO2/FiO2)更低〔mmHg:207.3(185.8,402.8)比320.2(226.2,361.5),P<0.05〕.多因素Logistic回归分析显示,SOFA评分〔优势比(OR)=2.818,P=0.022,β=1.036〕、治疗前BNP(OR=1.002,P=0.033,β=0.002)和治疗30 min HR(OR=1.140,P=0.032,β=0.131)为HFNC治疗失败的独立危险因素.ROC曲线分析显示,SOFA、治疗前BNP、治疗30 min HR和Logistic回归模型预估值预测HFNC失败的ROC曲线下面积(AUC)分别为0.840、0.859、0.860和0.962,均有较好的预测价值(均P<0.01).结论脱机后序贯HFNC治疗是ICU常用的氧疗手段之一,但并不是所有患者都能从中获益;SOFA评分、治疗前BNP和治疗30 min HR为外科ICU有创机械通气患者脱机后序贯HFNC治疗失败的独立危险因素,且各独立危险因素及回归模型均可预测HFNC治疗成功与否.
