Clinical efficacy of high-flow nasal cannula oxygen therapy with different oxygen flow rates in the treatment of patients with acute exacerbation of chronic obstructive pulmonary disease and analysis of influencing factors for short-term prognosis

WANG Jiao; LIU Yin; SHU Lu-ying; ZHOU Hong-bing; PENG Chang; CHEN Xiao-li

doi:10.16048/j.issn.2095-5561.2024.03.04

Abstract：Objective To investigate the clinical efficacy of high-flow nasal cannula oxygen therapy(HFNC) with different oxygen flow rates in the treatment of patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD),and screen the influencing factors of short-term prognosis in patients treated with HFNC setting oxygen flow rate at 60 L/min.Methods A total of 150 AECOPD patients admitted to Chongzhou People's Hospital from June 2022 to June 2023 were selected and divided into the low flow group,medium flow group and high flow group by random number table method,with 50 cases in each group.All the three groups were given HFNC treatment for 7 days,in which the oxygen flow rate of the low flow group was 30 L/min,the oxygen flow rate of the medium flow group was 40 L/min,and the oxygen flow rate of the high flow group was 60 L/min.The short-term efficacy at 24 hours after the treatment was compared among the three groups.Before and after the treatment,arterial blood gas indicators[partial pressure of carbon dioxide( PaCO2 ),oxygen partial pressure ( PaO2 )],pulmonary function[forced vital capacity ( FVC ),first second forced expiratory volume( FEV1),peak expiratory flow rate( PEF)],and symptom severity[chronic obstructive pulmonary disease assessment test( CAT),modified medical research council( mMRC) score]were compared among the three groups.Patients in the high flow group were followed up for 28 days after HFNC treatment,and divided into the good prognosis group( n=32) and the poor prognosis group ( n=18) based on their disease outcomes.The influencing factors of short-term prognosis in patients treated with HFNC setting oxygen flow rate at 60 L/min were analyzed.Results After the treatment,the PaCO2 of the three groups was lower than that before the treatment,while the PaO2,FVC,FEV1,and PEF of the three groups were higher than those before the treatment,with statistically significant differences( P<0.05) .After the treatment,PaCO2 in the high flow group and medium flow group was lower than that in the low flow group,and the high flow group was lower than the medium flow group,PaO2,FVC,FEV1 and PEF in the high flow group and medium flow group were higher than those in the low flow group,and the high flow group were higher than the medium flow group,with statistical significance (P<0.05).After the treatment,the CAT score and mMRC score of the three groups were lower than before the treatment,and the difference was statistically significant(P<0.05).After the treatment,the CAT score and mMRC score of the high flow group and the medium flow group were lower than those of the low flow group,and the high flow group was lower than the medium flow group,with statistical significance( P<0.05) .The total effective rate of the high flow group and the medium flow group was higher than that of the low flow group,and the high flow group was higher than the medium flow group,with statistical significance(P<0.05).Multivariate Logistic regression analysis showed that age,smoking history,acute physiology and chronic health scores,C-reactive protein,procalcitonin,PaCO2,PaO2,CAT score,mMRC score,and short-term efficacy of HFNC were independent risk factors affecting the short-term prognosis of high flow HFNC treatment for AECOPD(P<0.05).Conclusion High flow HFNC can better improve arterial blood gas and lung function in AECOPD patients,and enhance short-term efficacy.However,some patients are still affected by age,smoking history,acute physiology and chronic health scores,C-reactive protein,procalcitonin,PaCO2,PaO2,CAT score,mMRC score,and short-term efficacy of HFNC,and the prognosis is poor.This suggests that clinical measures can be developed early based on the above risk factors to improve short-term prognosis.