Effects of high-flow nasal cannula and noninvasive positive pressure ventilation for the hypoxemia following cardiac surgery
Yang Yi, Liu Nan, Hou Xiaotong, Sun Lizhong, Wang Hong, Jin Qi
2016, 37(5):
664-671.
doi:10.3969/j.issn.1006-7795.2016.05.021
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Objective To assess the efficacy of the high-flow nasal cannula(HFNC) and noninvasive positive pressure ventilation (NPPV) in hypoxemia following extubation after cardiac surgery, and the effect on re-intubation rate,intensive care unit(ICU) time and hospital stay.Methods Forty patients recovering from the cardiac surgery operation in the Center for Cardiac Intensive Care, Beijing Anzhen Hospital between Feb 1, 2016 and July 1, 2016, and meet the inclusion criterion after extubation,were investigated.The patients were random divided into two groups(simple randomization with RandA1.0 software),each group contained 20 patients:HFNC vs NPPV (age of year 52.9±7.8 vs 53.8±8.9,P>0.05;male 65% vs 70%,P>0.05;APACHE Ⅱ 9.4±2.2 vs 9.3±2.2,P>0.05).Initial settings:HFNC:the flux was 45L/min,temperature 37℃,and the fraction of inspired oxygen(FiO2) was adjusted to 60%-80%;NPPV:inspiratory pressure (IPAP) of 10-12 cm H2O(1cmH2O=0.098 kPa), expiratory pressure (EPAP) of 4-6 cmH2O, FiO2 60%-80%,radio of inspiration and expiration(I:E)1:1.5-2. The parameters of setting were adjusted with therapeutic effect and tolerance of patients.Make a comparison with the two groups in the clinical effect at different times(2 h,8 h,24 h and end of therapy),and to compare their complications, re-intubation rate,tracheotomy rate,intensive care unit(ICU) duration and hospitalization time.Results Compared to NPPV treatment group PaO2/FiO2 was higher in the HFNC group (P<0.05);and PaCO2 was lower in the HFNC group (P<0.05); respiratory rate (RR) and heart rate (HR) were lower in the HFNC group (P<0.05).The main complications such as flatulence (0 vs 20%,P<0.05)and intolerance (0 vs 25%,P<0.05) were less in the HFNC group.Therapeutic time was shorter in the HFNC;but no significant difference showed in the re-intubation rate,tracheotomy rate,ICU duration and hospitalization time.Conclusion For the patients of the hypoxemia after cardiac surgery postoperative extubation,with the better tolerance and fewer complications, HFNC can improve the oxygenation, decrease PaCO2,and slow the respiratory frequency, heart rate, decrease the mean arterial pressure,compared to the NPPV therapy. But no statistically difference showed in the re-intubation rate,tracheotomy rate,ICU duration and hospitalization time.
