Objective To evaluate the clinical efficacy of integrated treatment ( sequential noninvasive following invasive mechanical ventilation, bronchoscope suction, combined inhalation) in patients with acute respiratory failure induced by chronic obstructive pulmonary disease ( COPD) . Methods 59 elderly patients with COPD and acute respiratory failure in ICU fromJuly 2006 to July 2009 were enrolled in the study. The patients were randomized into three groups, ie. a non-invasive mechanical ventilation group ( NIV group) , a sequential non-invasive following invasive mechanical ventilation group ( SV group) , a integrated treatment group ( IT group) . APACHEⅡ score, clinical pulmonary infection score ( CPIS) ,arterial blood gas analysis, respiratory rate ( RR) , heart rate ( HR) , and mean artery blood pressure ( MAP)at 0 h, 3 h, 3 d, 12 d after treatment were recorded. Results With the extension of treatment time,APACHEⅡ score, CPIS score, RR, HR, PaCO2 , and white blood cells gradually reduced, while pH and PaO2 gradually increased in the three groups ( P lt;0. 05) . The differences in RR, HR, PaCO2 , and PaO2 at the time of 3 d and 12 d were significant between the three groups( P lt;0. 05) . The occurrence of pulmonary infection control ( PIC) window and ventilation associated pneumonia ( VAP) had no difference among the three groups( P gt;0. 05) . The duration of total mechanical ventilation, durations of ICU stay and hospital stay were shorter in SV group than those in NIV group( P lt;0. 05) . The duration of total mechanical ventilation,duration of invasive mechanical ventilation, durations of ICU stay and hospital stay were shorter in IT group than those in SV group( P lt;0. 05) . The incidence of VAP was higher in SV group than NIV group, but lower in IT group than SV group( P lt;0. 05) . Hospital mortality was lower in SV group than NIV group, and higher in IT group than SV group( P lt; 0. 05) . Conclusion In elderly COPD patients with acute respiratory failure, integrated treatment given early can reduce the duration of mechanical ventilation, the length of ICU and hospital stay, and decrease the morbidity of VAP and mortality.
ObjectiveTo compare the therapeutic effects of invasive-high-flow oxygen therapy (HFNC) and invasive-non-invasive ventilation (NIV) sequential strategies on severe respiratory failure caused by chronic obstructive pulmonary disease (COPD), and explore the feasibility of HFNC after extubation from invasive ventilation for COPD patients with severe respiratory failure.MethodsFrom October 2017 to October 2019, COPD patients with type Ⅱ respiratory failure who received invasive ventilation were randomly assigned to a HFNC group and a NIV group at 1: 1 in intensive care unit (ICU), when pulmonary infection control window appeared after treatments. The patients in the HFNC group received HFNC, while the patients in the NIV group received NIV after extubation. The primary endpoint was treatment failure rate. The secondary endpoints were blood gas analysis and vital signs at 1 hour, 24 hours, and 48 hours after extubation, total respiratory support time after extubation, daily airway care interventions, comfort scores, and incidence of nasal and facial skin lesions, ICU length of stay, total length of stay and 28-day mortality after extubation.ResultsOne hundred and twelve patients were randomly assigned to the HFNC group and the NIV group. After secondary exclusion, 53 patients and 52 patients in the HFNC group and the NIV group were included in the analysis respectively. The treatment failure rate in the HFNC group was 22.6%, which was lower than the 28.8% in the NIV group. The risk difference of the failure rate between the two groups was –6.2% (95%CI –22.47 - 10.43, P=0.509), which was significantly lower than the non-inferior effect of 9%. Analysis of the causes of treatment failure showed that treatment intolerance in the HFNC group was significantly lower than that in the NIV group, with a risk difference of –38.4% (95%CI –62.5 - –3.6, P=0.043). One hour after extubation, the respiratory rate of both groups increased higher than the baseline level before extubation (P<0.05). 24 hours after extubation, the respiratory rate in the HFNC group decreased to the baseline level, but the respiratory rate in the NIV group was still higher than the baseline level, and the respiratory rate in the HFNC group was lower than that in the NIV group [(19.1±3.8) vs. (21.7±4.5) times per minute, P<0.05]. 48 hours after extubation, the respiratory rates in the two groups were not significantly different from their baseline levels. The average daily airway care intervention in the NIV group was 9 (5 - 12) times, which was significantly higher than the 5 (4 - 7) times in the HFNC group (P=0.006). The comfort score of the HFNC group was significantly higher than that of the NIV group (8.6±3.2 vs. 5.7±2.8, P= 0.022), while the incidence of nasal and facial skin lesions in the HFNC group was significantly lower than that in the NIV group (0 vs. 9.6%, P=0.027). There was no significant difference in dyspnea score, length of stay and 28-day mortality between the two groups.ConclusionsThe efficacy of invasive-HFNC sequential treatment on COPD with severe respiratory failure is not inferior to that of invasive-NIV sequential strategy. The two groups have similar treatment failure rates, and HFNC has better comfort and treatment tolerance.
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.