Effect of high-flow nasal cannula oxygen therapy on patients with acute exacerbation of chronic obstructive pulmonary disease complicated with respiratory failure in plateau areas

Abstract

Objective To investigate the effect of high-flow nasal cannula oxygen therapy (HFNC) for the treatment of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and respiratory failure in plateau areas. Methods A total of 40 patients with AECOPD and respiratory failure in the Qinghai Provincial People's Hospital were retrospectively analyzed. They were divided into the treatment group and control group, with 20 cases in each group. According to their condition, all patients were given symptomatic treatment such as controlling infection, relieving bronchus and diluting sputum. On this basis, patients in the treatment group were treated with HFNC, while those in the control group were treated with the routine low-flow nasal cannula. The general data, respiratory frequency, arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2), pH value, sputum viscosity, success of oxygen therapy and occurrence of adverse reactions of patients were compared between the two groups before and 24 h after treatment. Results After treatment, the respiratory frequency [(15.5 ± 1.6) breaths/min vs. (18.8 ± 1.6) breaths/min, t = 6.612, P = 0.001] and PaCO2 [(49.4 ± 4.3) mmHg vs. (56.2 ± 4.6) mmHg, t = 4.848, P = 0.001] were significantly lower, and PaO2 [(61.1 ± 2.8) mmHg vs. (57.4 ± 3.3) mmHg, t = 3.798, P = 0.001)] and pH value [(7.38 ± 0.03) vs. (7.36 ± 0.03), t = 2.108, P = 0.042] were significantly higher in the treatment group than in the control group. In the treatment group, the respiratory frequency [(15.5 ± 1.6) breaths/min vs. (23.1 ± 1.9) breaths/min, t = 23.194, P = 0.001] and PaCO2 [(49.4 ± 4.3) mmHg vs. (62.2 ± 4.5) mmHg, t = 20.176, P = 0.001] were significantly lower, while PaO2 [(61.1 ± 2.8) mmHg vs. (45.5 ± 3.9) mmHg, t = 29.705, P = 0.001] and pH value [(7.38 ± 0.03) vs. (7.32 ± 0.03), t = 6.325 P < 0.001] were significantly higher after treatment than before treatment. In the control group, there were 4 cases of sputum viscosity degree Ⅰ, 8 cases of degree Ⅱ, and 8 cases of degree Ⅲ before treatment, and there were 5 cases of sputum viscosity degree Ⅰ, 7 cases of degree Ⅱ and 8 cases of degree Ⅲ after treatment. In the treatment group, there were 3 cases of sputum viscosity degree Ⅰ, 8 cases of degree Ⅱ, and 9 cases of degree Ⅲ before treatment, and there were 10 cases of sputum viscosity degree Ⅰ, 8 cases of degree Ⅱ, and 2 cases of degree Ⅲ after treatment. The sputum viscosity of the treatment group after treatment was significantly thinner than that of the control group (H = 2.163, P = 0.031) and that before treatment (H = 2.824, P = 0.005). In addition, compared with the control group, the success of HFNC in the treatment group was significantly higher (17/20 vs. 11/20, χ2 = 4.286, P = 0.038), while the incidence of adverse reactions decreased significantly (5/20 vs. 12/20, χ2 = 5.013, P = 0.025). Conclusions The HFNC has a remarkable curative effect on the AECOPD patients complicated with respiratory failure in plateau areas. It can obviously improve their respiratory frequency and blood gas condition, effectively dilute the sputum and reduce the sputum viscosity. It can also add comfort, decrease adverse reactions during oxygen therapy and non-invasive ventilation use, and shorten hospital stays of patients. Key words: Pulmonary disease, chronic obstructive; High-flow nasal cannulae oxygen therapy; Plateau area; Respiratory failure