The comparative study of high-flow nasal cannula oxygen therapy and non-invasive ventilation in treatment of acute respiratory distress syndrome induced by severe coronavirus disease 2019_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

WANG Chaoping ¹ , HUANG Xiuli ² , LUO Xiaobin ¹ , WU Xiaojuan ¹ , HAN Shuqing ³ , LIN Zhengze ⁴ ,  HE Zhengguang ⁵

1. Department of Respiratory and Critical Care Medicine, Suining Central Hospital, Suining, Sichuan 629000, P. R. China;
2. Department of Endocrinology and Metabolism, Suining Central Hospital, Suining, Sichuan 629000, P. R. China;
3. Department of Neurosurgery, Wuhan Red Cross Hospital, Wuhan, Hubei 430015, P. R. China;
4. Department of Critical Care Medicine, Suining Central Hospital, Suining, Sichuan 629000, P. R. China;
5. Department of Respiratory and Critical Care Medicine, Suining Third People’s Hospital, Suining, Sichuan 629000, P. R. China;

Corresponding author：

HE Zhengguang, Email: xnwcp2010@163.com

Keywords：

Corona virus disease 2019; Acute respiratory distress syndrome; High-flow nasal cannula oxygen therapy; Non-invasive ventilation

DOI：

10.7507/1671-6205.202006015

Video：

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Objective To compare the clinical efficacy and safety of high-flow nasal cannula oxygen therapy (HFNC) and non-invasive ventilation (NIV) in treatment of acute respiratory distress syndrome (ARDS) induced by coronavirus disease 2019 (COVID-19). Methods Sixty-eight patients with ARDS induced by COVID-19 in Wuhan Concorde Red Cross Hospital form January 25, 2020 to March 10, 2020 were included in the study. They were divided into an HFNC group (n=36) and an NIV group (n=36) according to the treatment. All patients received basic routine treatment, antiviral treatment and prevention therapy of secondary infection. The HFNC group received high-flow nasal cannula oxygen therapy, and the NIV group received NIV therapy. Then respiration and circulation parameters, comfort and tolerance, complications were compared between the two groups. Results After treatment for 3 days, 1 week, and 2 weeks in all patients with COVID-19 induced ARDS, respiratory rate (RR) was lower than that before therapy, arterial partial pressure of oxygen (PaO₂), pulse oxygen saturation (SpO₂), PaO₂/FiO₂ were higher than those before therapy (P<0.05), and therapeutic effect was time-dependent. But there was no significant difference of RR, PaO₂, SpO₂, PaO₂/FiO₂ between the HFNC group and the NIV group at different time points (P>0.05). After treatment for 2 weeks, the HFNC group patients' comfort, difficulty breathing, tolerance score were lower than the NIV group (P<0.05, P<0.01), the incidence rate of gastric distension and dry mouth etc. was lower than that in the NIV group (11.11% vs. 37.50%, P<0.05). There was no significant difference in rate of invasive mechanical ventilation or mortality between the two groups (P>0.05). Conclusions HFNC and NIV can improve respiratory and circulatory parameters of patients with COVID-19 induced ARDS. HFNC has better comfort and tolerance, and can reduce related complications.

Citation： WANG Chaoping, HUANG Xiuli, LUO Xiaobin, WU Xiaojuan, HAN Shuqing, LIN Zhengze, HE Zhengguang. The comparative study of high-flow nasal cannula oxygen therapy and non-invasive ventilation in treatment of acute respiratory distress syndrome induced by severe coronavirus disease 2019. Chinese Journal of Respiratory and Critical Care Medicine, 2022, 21(1): 20-24. doi: 10.7507/1671-6205.202006015 Copy

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2.	中华医学会呼吸病学会呼吸危重症医学学组. 急性呼吸窘迫综合征患者机械通气指南(试行). 中华医学杂志, 2016, 96(6): 404-424.
3.	Cinesi Gomez C, Penuelas Rodrlguez O, et al. Clinical consensus recommendations regarding non-invasive respiratory support in the adult patient with acute respiratory failure secondary to SARS-CoV-2 infection. Med Intensiva (Engl Ed), 2020, 44(7): 429-438.
4.	Tinelli V, Cabrini L, Fominskiy E, et al. High flow nasal cannula oxygen vs. conventional oxygen therapy and noninvasive ventilation in emergency department patients: a systematic review and meta-analysis. J Emerg Med, 2019, 57(3): 322-328.
5.	陆洋, 沈浩亮, 刘向新, 等. 重症急性胰腺炎合并急性呼吸窘迫综合征经鼻高流量氧疗治疗失败的相关危险因素分析. 东南大学学报(医学版), 2018, 37(6): 951-956.
6.	Roca O, Messika J, Caralt B, et al. Predicting success of high flow nasal cannula in pneumonia patients with hypoxemic respiratory failure: the utility of the ROX index. J Cirt Care, 2016, 35: 200-205.
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9.	ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, Thompson BT, et al. Acute respiratory distress syndrome: the Berlin definition. JAMA, 2012, 307(23): 2526-2533.
10.	Tiruvoipati R, Lewis D, Haji K, et al. High-flow nasal oxygen vs high-flow face mask: a randomized crossover trial in extubated patients. J Crit Care, 2010, 25(3): 463-468.
11.	Huang CL, Wang YM, Li XW, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet, 2020, 395(10223): 497-506.
12.	李远征, 李锐, 李春雨, 等. 新型冠状病毒肺炎危重症患者的呼吸支持及管理策略. 长治医学院学报, 2020, 34(1): 18-21.
13.	Beng Leong L, Wei Ming N, Wei Feng L. High flow nasal cannula oxygen versus noninvasive ventilation in adult acute respiratory failure: a systematic review of randomized-controlled trials. Eur J Eemerg Med, 2019, 26(1): 9-18.
14.	朱庆程, 曹鹏, 谈定玉, 等. 经鼻高流量氧疗与无创机械通气治疗创伤相关肺损伤的疗效比较. 实用临床医药杂志, 2019, 23(23): 20-23.
15.	王健, 马新华, 李莉, 等. 经鼻高流量氧疗治疗Ⅰ型呼吸衰竭的疗效分析. 中国现代医学杂志, 2018, 28(14): 65-70.
16.	谈定玉, 凌冰玉, 孙家艳, 等. 经鼻高流量氧疗与无创正压通气比较治疗慢性阻塞性肺疾病合并中度呼吸衰竭的观察性队列研究. 中华急诊医学杂志, 2018, 27(4): 361-366.
17.	Panadero C, Abad-Fernández A, Rio-Ramirez MT, et al. High-flow nasal cannula for acute respiratory distress syndrome (ARDS) due to COVID-19. Multidiscip Respir Med, 2020, 15(1): 693.
18.	Suffredini DA, Allison MG. A rationale for use of high flow nasal cannula for select patients with suspected or confirmed severe acute respiratory syndrome coronavirus-2 infection. J Intensive Care Med, 2021, 36(1): 9-17.
19.	马德胜, 罗书航, 马莉, 等. 经鼻高流量氧疗在急性呼吸窘迫综合征的临床实践进展. 临床肺科杂志, 2020, 25(5): 785-788.
20.	Hill NS, Ruthazer R. Predicting outcomes of high-flow nasal cannula for acute respiratory distress syndrome. An Index that ROX. Am J Respir Crit Med, 2019, 199(11): 1300-1302.
21.	李雯莉, 孙虎, 李丹丹, 等. 高流量氧疗与无创正压通气对呼衰患者的影响. 中华急诊医学杂志, 2018, 27(4): 381-383.

1. Xu Z, Shi L, Wang YJ, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Res Med, 2020, 22(8): 420-422.
2. 中华医学会呼吸病学会呼吸危重症医学学组. 急性呼吸窘迫综合征患者机械通气指南(试行). 中华医学杂志, 2016, 96(6): 404-424.
3. Cinesi Gomez C, Penuelas Rodrlguez O, et al. Clinical consensus recommendations regarding non-invasive respiratory support in the adult patient with acute respiratory failure secondary to SARS-CoV-2 infection. Med Intensiva (Engl Ed), 2020, 44(7): 429-438.
4. Tinelli V, Cabrini L, Fominskiy E, et al. High flow nasal cannula oxygen vs. conventional oxygen therapy and noninvasive ventilation in emergency department patients: a systematic review and meta-analysis. J Emerg Med, 2019, 57(3): 322-328.
5. 陆洋, 沈浩亮, 刘向新, 等. 重症急性胰腺炎合并急性呼吸窘迫综合征经鼻高流量氧疗治疗失败的相关危险因素分析. 东南大学学报(医学版), 2018, 37(6): 951-956.
6. Roca O, Messika J, Caralt B, et al. Predicting success of high flow nasal cannula in pneumonia patients with hypoxemic respiratory failure: the utility of the ROX index. J Cirt Care, 2016, 35: 200-205.
7. 倪忠, 秦浩, 李洁, 等; 中华医学会呼吸病学分会呼吸治疗学组. 新型冠状病毒肺炎患者经鼻高流量氧疗使用管理专家共识. 中国呼吸与危重监护杂志, 2020, 19(2): 110-115.
8. 国家卫生健康委办公厅, 国家中医药管理局办公室. 关于印发新型冠状病毒感染的肺炎诊疗方案(试行第五版). 国卫办医函[2020]103号.
9. ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, Thompson BT, et al. Acute respiratory distress syndrome: the Berlin definition. JAMA, 2012, 307(23): 2526-2533.
10. Tiruvoipati R, Lewis D, Haji K, et al. High-flow nasal oxygen vs high-flow face mask: a randomized crossover trial in extubated patients. J Crit Care, 2010, 25(3): 463-468.
11. Huang CL, Wang YM, Li XW, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet, 2020, 395(10223): 497-506.
12. 李远征, 李锐, 李春雨, 等. 新型冠状病毒肺炎危重症患者的呼吸支持及管理策略. 长治医学院学报, 2020, 34(1): 18-21.
13. Beng Leong L, Wei Ming N, Wei Feng L. High flow nasal cannula oxygen versus noninvasive ventilation in adult acute respiratory failure: a systematic review of randomized-controlled trials. Eur J Eemerg Med, 2019, 26(1): 9-18.
14. 朱庆程, 曹鹏, 谈定玉, 等. 经鼻高流量氧疗与无创机械通气治疗创伤相关肺损伤的疗效比较. 实用临床医药杂志, 2019, 23(23): 20-23.
15. 王健, 马新华, 李莉, 等. 经鼻高流量氧疗治疗Ⅰ型呼吸衰竭的疗效分析. 中国现代医学杂志, 2018, 28(14): 65-70.
16. 谈定玉, 凌冰玉, 孙家艳, 等. 经鼻高流量氧疗与无创正压通气比较治疗慢性阻塞性肺疾病合并中度呼吸衰竭的观察性队列研究. 中华急诊医学杂志, 2018, 27(4): 361-366.
17. Panadero C, Abad-Fernández A, Rio-Ramirez MT, et al. High-flow nasal cannula for acute respiratory distress syndrome (ARDS) due to COVID-19. Multidiscip Respir Med, 2020, 15(1): 693.
18. Suffredini DA, Allison MG. A rationale for use of high flow nasal cannula for select patients with suspected or confirmed severe acute respiratory syndrome coronavirus-2 infection. J Intensive Care Med, 2021, 36(1): 9-17.
19. 马德胜, 罗书航, 马莉, 等. 经鼻高流量氧疗在急性呼吸窘迫综合征的临床实践进展. 临床肺科杂志, 2020, 25(5): 785-788.
20. Hill NS, Ruthazer R. Predicting outcomes of high-flow nasal cannula for acute respiratory distress syndrome. An Index that ROX. Am J Respir Crit Med, 2019, 199(11): 1300-1302.
21. 李雯莉, 孙虎, 李丹丹, 等. 高流量氧疗与无创正压通气对呼衰患者的影响. 中华急诊医学杂志, 2018, 27(4): 381-383.

Chinese Journal of Respiratory and Critical Care Medicine

The comparative study of high-flow nasal cannula oxygen therapy and non-invasive ventilation in treatment of acute respiratory distress syndrome induced by severe coronavirus disease 2019

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