Effect of high-flow nasal cannulae and non-invasive positive pressure ventilation alternately on chronic obstructive pulmonary disease patients complicated with type II respiratory failure

Abstract

Objective To explore the clinical effect of high-flow nasal cannulae (HFNC) and non-invasive positive pressure ventilation alternately on chronic obstructive pulmonary disease (COPD) patients with type Ⅱ respiratory failure. Methods Totally 90 patients of COPD complicated with type Ⅱ respiratory failure were divided into the observation group (45 cases) and control group (45 cases) in the Department of Intensive Care Unit, Quzhou Municipal Hospital of TCM. The patients in the control group were treated with non-invasive positive pressure ventilation on the basis of routine treatment, and the patients in the observation group were alternately treated with HFNC-non-invasive positive pressure ventilation on the basis of routine treatment. The therapeutic effective rate, hospital stay, tracheal intubation rate, 28-day mortality, partial pressure of carbon dioxide in arterial (PaCO2), arterial partial pressure of oxygen (PaO2), pH value, respiratory rate, heart rate and sputum viscosity were compared between these two groups. Results After treatment, in the observation group, the effective rate (91.1% vs. 73.3%, χ2 = 4.865, P = 0.027), PaO2 [(79 ± 15) mmHg vs. (69 ± 14) mmHg, t = 3.006, P = 0.003] and pH value [(7.53 ± 1.01) vs. (7.04 ± 1.06), t = 2.245, P = 0.027)] were significantly higher, while the hospital stay of ICU [(8.6 ± 1.6) d vs. (10.4 ± 2.5) d, t = 4.091, P < 0.001], tracheal intubation rate (6.7% vs. 24.4%, χ2 = 5.414, P = 0.020), PaCO2 [(52 ± 13) mmHg vs. (70 ± 13) mmHg, t = 6.564, P < 0.001], respiratory rate [(77 ± 8) breaths/min vs. (88 ± 9) breaths/min, t = 6.310, P < 0.001] and heart rate [(17.6 ± 3.0) beats/min vs. (19.0 ± 2.9) beats/min, t= 2.238, P= 0.028] were significantly lower than those in the control group. There were 20 cases of degree Ⅰ sputum viscosity, 13 cases degree Ⅱ and 12 cases degree Ⅲ in the observation group after treatment, and 9 cases degree Ⅰ, 15 cases degree Ⅱ and 21 cases degree Ⅲ in the control group after treatment. There was significant difference in the sputum viscosity between these two groups (χ2= 3.876, P= 0.049). Conclusion The alternative therapy of HFNC and non-invasive positive pressure ventilation is a new potential respiratory support method for COPD patients complicated with type Ⅱ respiratory failure. Key words: Pulmonary disease, chronic obstructive; High-flow nasal cannulae; Non-invasive positive pressure ventilation; Respiratory failure