Patients with acute exacerbation of chronic obstructive pulmonary disease(COPD)often suffer from respiratory failure and require respiratory support therapy.High-flow nasal cannula oxygen therapy(HFNC)and non-invasive...Patients with acute exacerbation of chronic obstructive pulmonary disease(COPD)often suffer from respiratory failure and require respiratory support therapy.High-flow nasal cannula oxygen therapy(HFNC)and non-invasive positive pressure ventilation(NIPPV)are commonly used non-invasive respiratory support methods.HFNC can provide precisely heated and humidified high-flow oxygen,reducing dead space and increasing alveolar ventilation.NIPPV can supply stable high-concentration oxygen and improve gas exchange.This article reviews the application of HFNC and NIPPV in the acute exacerbation stage of COPD,aiming to provide references for reasonable clinical selection.展开更多
Clinical DataCase selection: 100 cases who met thediagnostic criteria of senile dementiaformulated by American Association ofPsychiatry in Handbook of Diagnosis andStatistics (DSM-Ⅲ-R, 3rd revised edition)
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
BACKGROUND Hydrofluoric acid(HF)is one of the most common causes of chemical burns.HF burns can cause wounds that deepen and progress aggressively.As a result,HF burns are often severe even if they involve a small are...BACKGROUND Hydrofluoric acid(HF)is one of the most common causes of chemical burns.HF burns can cause wounds that deepen and progress aggressively.As a result,HF burns are often severe even if they involve a small area of the skin.Published cases of HF burns have mostly reported small HF burn areas.Few cases of HF inhalation injury have been reported to date.CASE SUMMARY A 24-year-old man suffered from extensive hydrofluoric acid burns covering 60%of the total body surface area(TBSA),including deep second degree burns on 47%and third degree burns on 13%of the TBSA,after he fell into a pickling pool containing 15%HF.Comprehensive treatments were carried out after the patient was admitted.Ventricular fibrillation occurred 9 times within the first 2 h,and the lowest serum Ca2+concentration was 0.192 mmol/L.A dose of calcium gluconate(37 g)was intravenously supplied during the first 24 h,and the total amount of calcium gluconate supplementation was 343 g.Extracorporeal membrane oxygenation(ECMO)was applied for 8 d to handle the acute respiratory distress syndrome(ARDS)induced by the HF inhalation injury.The patient was discharged after 99 d of comprehensive treatment,including skin grafting.CONCLUSION Extensive HF burns combined with an inhalation injury led to a potentially fatal electrolyte imbalance and ARDS.Adequate and timely calcium supplementation and ECMO application were the keys to successful treatment of the patient.展开更多
Aim: The purpose of this case study was to examine the sleep quality of patients receiving noninvasive positive pressure ventilation (NPPV) or nasal high-flow oxygen therapy (NHF) in an intensive care unit and to inve...Aim: The purpose of this case study was to examine the sleep quality of patients receiving noninvasive positive pressure ventilation (NPPV) or nasal high-flow oxygen therapy (NHF) in an intensive care unit and to investigate what types of nursing support are offered to such patients. Methods: We examined one patient each for NPPV and NHF. Polysomnography (PSG), review of the patient charts, and semi-structured interviews were used to collect the data for analysis. Results: Patients treated with NPPV or NHF demonstrated a noticeable reduction in deep sleep, with most of their sleep being shallow. Their sleep patterns varied greatly from those of healthy individuals. These results suggest that, in addition to experiencing extremely fragmented sleep, sleep in these patients was more likely to be interrupted by nursing interventions, such as during auscultation of breath sounds. Furthermore, it was revealed that “anxiety or discomfort that accompanies the mask or air pressure” in patients treated with NPPV and “discomfort that accompanies the nasal cannula or NHF circuit” in patients treated with NHF may be primary causes of disrupted sleep. Our results suggest a need for nursing care aimed at improving sleep quality in patients treated with NPPV or NHF.展开更多
BACKGROUND Since the outbreak of coronavirus disease 2019(COVID-19)in Wuhan,China in December 2019,the overall fatality rate of severe and critical patients with COVID-19 is high and the effective therapy is limited.C...BACKGROUND Since the outbreak of coronavirus disease 2019(COVID-19)in Wuhan,China in December 2019,the overall fatality rate of severe and critical patients with COVID-19 is high and the effective therapy is limited.CASE SUMMARY In this case report,we describe a case of the successful combination of the prone position(PP)and high-flow nasal oxygen(HFNO)therapy in a spontaneously breathing,severe COVID-19 patient who presented with fever,fatigue and hypoxemia and was diagnosed by positive throat swab COVID-19 RNA testing.The therapy significantly improved the patient's clinical symptoms,oxygenation status,and radiological characteristics of lung injury during hospitalization,and the patient showed good tolerance and avoided intubation.Additionally,we did not find that medical staff wearing optimal airborne personal protective equipment(PPE)were infected by the new coronavirus in our institution.CONCLUSION We conclude that the combination of PP and HFNO could benefit spontaneously breathing,severe COVID-19 patients.The therapy does not increase risk of healthcare workers wearing optimal airborne PPE to become infected with virus particles.展开更多
Coronavirus disease 2019(COVID-19)related acute respiratory distress syndrome(ARDS)is a severe complication of infection with severe acute respiratory syndrome coronavirus 2,and the primary cause of death in the curre...Coronavirus disease 2019(COVID-19)related acute respiratory distress syndrome(ARDS)is a severe complication of infection with severe acute respiratory syndrome coronavirus 2,and the primary cause of death in the current pandemic.Critically ill patients often undergo extracorporeal membrane oxygenation(ECMO)therapy as the last resort over an extended period.ECMO therapy requires sedation of the patient,which is usually achieved by intravenous administration of sedatives.The shortage of intravenous sedative drugs due to the ongoing pandemic,and attempts to improve treatment outcome for COVID-19 patients,drove the application of inhaled sedation as a promising alternative for sedation during ECMO therapy.Administration of volatile anesthetics requires an appropriate delivery.Commercially available ones are the anesthetic gas reflection systems AnaConDa®and MIRUSTM,and each should be combined with a gas scavenging system.In this review,we describe respiratory management in COVID-19 patients and the procedures for inhaled sedation during ECMO therapy of COVID-19 related ARDS.We focus particularly on the technical details of administration of volatile anesthetics.Furthermore,we describe the advantages of inhaled sedation and volatile anesthetics,and we discuss the limitations as well as the requirements for safe application in the clinical setting.展开更多
Objective:To analyze the curative effect of humidified high-flow nasal oxygen therapy combined with alveolar lavage in patients with severe pneumonia and respiratory failure.Methods:120 patients with severe pneumonia ...Objective:To analyze the curative effect of humidified high-flow nasal oxygen therapy combined with alveolar lavage in patients with severe pneumonia and respiratory failure.Methods:120 patients with severe pneumonia complicated with respiratory failure admitted to the Third People’s Hospital of Xining from July 2021 to December 2022 were randomly divided into two groups:group A and group B.The patients in group A were given humidified high-flow nasal oxygen therapy combined with alveolar lavage,whereas those in group B were given humidified high-flow nasal oxygen therapy.The treatment efficacy,blood gas analysis results,and differences in inflammatory mediators were compared between the two groups.Results:The curative effect in group A(96.67%)was significantly higher than that in group B(81.67%),P<0.05;the partial pressure of carbon dioxide(PaCO2),partial pressure of oxygen(PaO2),oxygen saturation(SpO2),and Horowitz index(P/F)of group A were significantly better than group B,P<0.05;the interleukin 6(IL-6),tumor necrosis factor alpha(TNF-α),and C-reactive protein(CRP)levels,white blood cell(WBC)count,serum procalcitonin(PCT),and neutrophil(N)percentage of group A were significantly lower than those of group B,P<0.05.Conclusion:For patients with severe pneumonia complicated with respiratory failure,alveolar lavage,on the basis of humidified high-flow oxygen therapy,can inhibit local inflammation,improve blood gas analysis results,promote disease recovery,and improve the clinical treatment effect。展开更多
【目的】探讨气管插管序贯经鼻高流量吸氧在重症医学病房(intensive care unit,ICU)机械通气脱机拔管后患者中的应用效果。【方法】选取2023年1月至2025年1月在本院接受治疗的100例ICU机械通气患者作为研究对象,按照随机数字表法将患者...【目的】探讨气管插管序贯经鼻高流量吸氧在重症医学病房(intensive care unit,ICU)机械通气脱机拔管后患者中的应用效果。【方法】选取2023年1月至2025年1月在本院接受治疗的100例ICU机械通气患者作为研究对象,按照随机数字表法将患者分为对照组和观察组,每组50例。两组患者均根据统一标准实施脱机拔管操作,观察组在拔管后采用气管插管序贯经鼻高流量吸氧,对照组采用面罩6 L/min吸氧。比较两组患者ICU机械通气患者脱机拔管后的血氧指标[血氧饱和度(oxygen saturation,SaO_(2))、动脉血氧分压(partial pressure of oxygen,PaO_(2))、氧合指数(oxygenation index,OI)]、拔管后48 h内再插管率、ICU住院时间。【结果】干预48 h后,两组患者SaO_(2)、PaO_(2)、OI值均高于干预前,且观察组患者高于对照组(P<0.05)。两组拔管后48 h内的再插管率、ICU住院时间比较,差异无统计学意义(P>0.05)。【结论】气管插管序贯经鼻高流量吸氧在ICU机械通气脱机拔管后患者中的应用效果显著,患者血氧指标显著改善,且安全性较高。展开更多
Purpose:To evaluate the effectiveness of oxygen nebulization at preventing radiotherapyinduced mucositis in patients with nasopharyngeal cancer.Methods:Sixty patients with nasopharyngeal cancer treated with simultaneo...Purpose:To evaluate the effectiveness of oxygen nebulization at preventing radiotherapyinduced mucositis in patients with nasopharyngeal cancer.Methods:Sixty patients with nasopharyngeal cancer treated with simultaneous integrated boost intensity-modulated radiotherapy were randomly assigned to oxygen nebulization or ultrasonic nebulization groups;treatment was once daily for 20 minutes.All patients received routine oral care.We compared saliva pH and volume,food intake,and change in oral mucosa during radiotherapy,and dry mouth and sore throat after radiotherapy between the two groups.Results:There were significant differences in the incidence of grade III or IV mucositis,saliva volume and pH,and dry mouth and sore throat between the two groups when the total dose was 33 Gy(p<0.05 or p<0.01).Conclusion:Oxygen nebulization reduces radiotherapy-induced mucositis and relieves symptoms such as dry mouth and sore throat in patients with nasopharyngeal cancer.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
基金2022 Inner Mongolia Autonomous Region Health and Wellness Science and Technology Program Project(Project No.:202201533)。
文摘Patients with acute exacerbation of chronic obstructive pulmonary disease(COPD)often suffer from respiratory failure and require respiratory support therapy.High-flow nasal cannula oxygen therapy(HFNC)and non-invasive positive pressure ventilation(NIPPV)are commonly used non-invasive respiratory support methods.HFNC can provide precisely heated and humidified high-flow oxygen,reducing dead space and increasing alveolar ventilation.NIPPV can supply stable high-concentration oxygen and improve gas exchange.This article reviews the application of HFNC and NIPPV in the acute exacerbation stage of COPD,aiming to provide references for reasonable clinical selection.
文摘Clinical DataCase selection: 100 cases who met thediagnostic criteria of senile dementiaformulated by American Association ofPsychiatry in Handbook of Diagnosis andStatistics (DSM-Ⅲ-R, 3rd revised edition)
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.
基金Supported by the National Nature Science Foundation of China,No.81701899 and No.81671911Youth Incubation Plan of the Military Medical Science and Technology,No.16QNP091+3 种基金Naval Medical University Youth Start-up Fund,No.2016QN10the Logistics Scientific Research Program,No.AWS14C001-4Jiangsu Provincial Health Commission Project,No.H2017071Suzhou Clinical Medical Center Construction Program,No.SZZXJ201506
文摘BACKGROUND Hydrofluoric acid(HF)is one of the most common causes of chemical burns.HF burns can cause wounds that deepen and progress aggressively.As a result,HF burns are often severe even if they involve a small area of the skin.Published cases of HF burns have mostly reported small HF burn areas.Few cases of HF inhalation injury have been reported to date.CASE SUMMARY A 24-year-old man suffered from extensive hydrofluoric acid burns covering 60%of the total body surface area(TBSA),including deep second degree burns on 47%and third degree burns on 13%of the TBSA,after he fell into a pickling pool containing 15%HF.Comprehensive treatments were carried out after the patient was admitted.Ventricular fibrillation occurred 9 times within the first 2 h,and the lowest serum Ca2+concentration was 0.192 mmol/L.A dose of calcium gluconate(37 g)was intravenously supplied during the first 24 h,and the total amount of calcium gluconate supplementation was 343 g.Extracorporeal membrane oxygenation(ECMO)was applied for 8 d to handle the acute respiratory distress syndrome(ARDS)induced by the HF inhalation injury.The patient was discharged after 99 d of comprehensive treatment,including skin grafting.CONCLUSION Extensive HF burns combined with an inhalation injury led to a potentially fatal electrolyte imbalance and ARDS.Adequate and timely calcium supplementation and ECMO application were the keys to successful treatment of the patient.
文摘Aim: The purpose of this case study was to examine the sleep quality of patients receiving noninvasive positive pressure ventilation (NPPV) or nasal high-flow oxygen therapy (NHF) in an intensive care unit and to investigate what types of nursing support are offered to such patients. Methods: We examined one patient each for NPPV and NHF. Polysomnography (PSG), review of the patient charts, and semi-structured interviews were used to collect the data for analysis. Results: Patients treated with NPPV or NHF demonstrated a noticeable reduction in deep sleep, with most of their sleep being shallow. Their sleep patterns varied greatly from those of healthy individuals. These results suggest that, in addition to experiencing extremely fragmented sleep, sleep in these patients was more likely to be interrupted by nursing interventions, such as during auscultation of breath sounds. Furthermore, it was revealed that “anxiety or discomfort that accompanies the mask or air pressure” in patients treated with NPPV and “discomfort that accompanies the nasal cannula or NHF circuit” in patients treated with NHF may be primary causes of disrupted sleep. Our results suggest a need for nursing care aimed at improving sleep quality in patients treated with NPPV or NHF.
文摘BACKGROUND Since the outbreak of coronavirus disease 2019(COVID-19)in Wuhan,China in December 2019,the overall fatality rate of severe and critical patients with COVID-19 is high and the effective therapy is limited.CASE SUMMARY In this case report,we describe a case of the successful combination of the prone position(PP)and high-flow nasal oxygen(HFNO)therapy in a spontaneously breathing,severe COVID-19 patient who presented with fever,fatigue and hypoxemia and was diagnosed by positive throat swab COVID-19 RNA testing.The therapy significantly improved the patient's clinical symptoms,oxygenation status,and radiological characteristics of lung injury during hospitalization,and the patient showed good tolerance and avoided intubation.Additionally,we did not find that medical staff wearing optimal airborne personal protective equipment(PPE)were infected by the new coronavirus in our institution.CONCLUSION We conclude that the combination of PP and HFNO could benefit spontaneously breathing,severe COVID-19 patients.The therapy does not increase risk of healthcare workers wearing optimal airborne PPE to become infected with virus particles.
文摘Coronavirus disease 2019(COVID-19)related acute respiratory distress syndrome(ARDS)is a severe complication of infection with severe acute respiratory syndrome coronavirus 2,and the primary cause of death in the current pandemic.Critically ill patients often undergo extracorporeal membrane oxygenation(ECMO)therapy as the last resort over an extended period.ECMO therapy requires sedation of the patient,which is usually achieved by intravenous administration of sedatives.The shortage of intravenous sedative drugs due to the ongoing pandemic,and attempts to improve treatment outcome for COVID-19 patients,drove the application of inhaled sedation as a promising alternative for sedation during ECMO therapy.Administration of volatile anesthetics requires an appropriate delivery.Commercially available ones are the anesthetic gas reflection systems AnaConDa®and MIRUSTM,and each should be combined with a gas scavenging system.In this review,we describe respiratory management in COVID-19 patients and the procedures for inhaled sedation during ECMO therapy of COVID-19 related ARDS.We focus particularly on the technical details of administration of volatile anesthetics.Furthermore,we describe the advantages of inhaled sedation and volatile anesthetics,and we discuss the limitations as well as the requirements for safe application in the clinical setting.
文摘Objective:To analyze the curative effect of humidified high-flow nasal oxygen therapy combined with alveolar lavage in patients with severe pneumonia and respiratory failure.Methods:120 patients with severe pneumonia complicated with respiratory failure admitted to the Third People’s Hospital of Xining from July 2021 to December 2022 were randomly divided into two groups:group A and group B.The patients in group A were given humidified high-flow nasal oxygen therapy combined with alveolar lavage,whereas those in group B were given humidified high-flow nasal oxygen therapy.The treatment efficacy,blood gas analysis results,and differences in inflammatory mediators were compared between the two groups.Results:The curative effect in group A(96.67%)was significantly higher than that in group B(81.67%),P<0.05;the partial pressure of carbon dioxide(PaCO2),partial pressure of oxygen(PaO2),oxygen saturation(SpO2),and Horowitz index(P/F)of group A were significantly better than group B,P<0.05;the interleukin 6(IL-6),tumor necrosis factor alpha(TNF-α),and C-reactive protein(CRP)levels,white blood cell(WBC)count,serum procalcitonin(PCT),and neutrophil(N)percentage of group A were significantly lower than those of group B,P<0.05.Conclusion:For patients with severe pneumonia complicated with respiratory failure,alveolar lavage,on the basis of humidified high-flow oxygen therapy,can inhibit local inflammation,improve blood gas analysis results,promote disease recovery,and improve the clinical treatment effect。
文摘Purpose:To evaluate the effectiveness of oxygen nebulization at preventing radiotherapyinduced mucositis in patients with nasopharyngeal cancer.Methods:Sixty patients with nasopharyngeal cancer treated with simultaneous integrated boost intensity-modulated radiotherapy were randomly assigned to oxygen nebulization or ultrasonic nebulization groups;treatment was once daily for 20 minutes.All patients received routine oral care.We compared saliva pH and volume,food intake,and change in oral mucosa during radiotherapy,and dry mouth and sore throat after radiotherapy between the two groups.Results:There were significant differences in the incidence of grade III or IV mucositis,saliva volume and pH,and dry mouth and sore throat between the two groups when the total dose was 33 Gy(p<0.05 or p<0.01).Conclusion:Oxygen nebulization reduces radiotherapy-induced mucositis and relieves symptoms such as dry mouth and sore throat in patients with nasopharyngeal cancer.
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.
