Comparison of therapeutic efficacy between non-invasive positive pressure ventilation and high-flow nasal cannula oxygen therapy in patients with acute exacerbation of chronic obstructive pulmonary disease after extubation

Li Xiang; Wang Jianping; Shang Si; Li Yan; Feng Yaqi; Dai Bin; Jing Tianyu

doi:10.11986/j.issn.1673-873X.2025.05.07

Abstract：Objective To explore the effects of two treatment modalities-non-invasive positive pressure ventilation(NIPPV)and high-flow nasal cannula(HFNC)oxygen therapy-on blood gas parameters and clinical prognosis indicators in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)after extubation,aiming to provide a reference for clinical decision-making.Methods The study recruited 130 AECOPD patients treated at Beijing Shijitan Hospital,Capital Medical University,from March 2020 to April 2024 as research participants.Patients were assigned to two groups using a ran-dom number table:the NIPPV group and the HFNC group,with 65 patients in each group.Patients in the NIPPV group re-ceived NIPPV in addition to conventional treatment,while patients in the HFNC group received HFNC in addition to conven-tional treatment.Key blood gas parameters(arterial partial pressure of oxygen[PaO2],arterial partial pressure of carbon di-oxide[PaCO2],and blood pH)and key inflammatory markers(C-reactive protein[CRP],procalcitonin[PCT],and white blood cell count[WBC])were compared between the two groups before treatment and 24 hours after treatment.Serum potas-sium and sodium levels were compared between the two groups before treatment and 5 days after treatment.The duration of ventilation therapy,incidence of pulmonary infection,reintubation rate,total hospital stay,and 28-day mortality were com-pared between the two groups.Results Twenty-four hours after treatment,PaO2 levels and pH values were significantly higher in both groups compared to before treatment;furthermore,compared to the NIPPV group,PaO2 levels and pH values were higher in the HFNC group,with statistically significant differences(P＜0.05).PaCO2 levels were significantly lower in both groups compared to before treatment;moreover,compared to the NIPPV group,PaCO2 levels were lower in the HFNC group,with a statistically significant difference(P＜0.05).Twenty-four hours after treatment,CRP,PCT,and WBC levels were significantly lower in both groups compared to before treatment;further comparative analysis showed that CRP,PCT,and WBC levels in the HFNC group were significantly lower than those in the NIPPV group after treatment,with statistically significant differences(P＜0.05).Five days after treatment,serum potassium and sodium levels increased in the HFNC group,while only serum potassium levels increased in the NIPPV group;further analysis indicated that serum potassium levels in the HFNC group were higher than those in the NIPPV group after treatment,with a statistically significant difference(P＜0.05).There were no statistically significant differences between the two groups in the incidence of pulmonary infection,reintubation rate,or 28-day mortality(P＞0.05).Compared to the NIPPV group,the duration of ventilation therapy and total hospital stay were significantly shorter in the HFNC group(P＜0.05).Conclusion HFNC demonstrates significant therapeutic efficacy in AECOPD pa-tients with respiratory failure after extubation.Compared to NIPPV,HFNC not only effectively improves patients' blood gas parame-ters but also corrects electrolyte imbalance,justifying its clinical promotion and application.