Comparison of the efficacy of BiPAP non-invasive ventilation and nasal high flow oxygen therapy in the treatment of acute left heart failure with hypoxemia in elderly patients with different grades

FEI You-sheng; ZHANG Chao; GAO Jie; XU Jun-jiao; ZHAO Cheng-gang

doi:10.3969/j.issn.1672-5301.2024.01.010

Abstract：Objective To compare the efficacy of biphasic positive airway pressure(BiPAP)non-invasive ventilation and high flow nasal oxygen therapy(HFNC)in the treatment of acute left ventricular failure with hypoxemia in elderly patients with different grades.Methods One hundred and eighty elderly patients with acute left heart failure and hypoxemia admitted to the emergency department of Shanghai Nanxiang Hospitals from June 2021 to May 2023 were selected as the research subjects.They were divided into Group A and Group B with 90 patients each using a lottery method.Group A received BiPAP non-invasive ventilation,and Group B received HFNC treatment.The venous and arterial blood from all the patients were collected immediately,6 hours,and 24 hours after rescue treatment;and the levels of N-terminal B-type natriuretic peptide precursor(NT-proBNP),copeptin,and blood gas analysis were measured,and the tracheal intubation rate and prognosis of the two groups of patients were record.Results After the treatment,the total effective rates of both groups were 88.89%.However,in Group B,the effective rates of Grade Ⅱ and Grade Ⅲ patients were 90.70%and 78.95%,respectively,which were higher than those of 89.66%and 88.89%in Group A and the effective rates of Grade Ⅳ patients were 78.95%lower than that of 87.50%in Group A,but the differences were not statistically significant(P>0.05).At immediate,6 h,and 24 h after treatment,the trend of NT-proBNP levels in the two groups was grade Ⅱ<grade Ⅲ<grade Ⅳ(P<0.05),while the overall difference in copeptin levels among patients of different grades was not significant(P>0.05).Within 24 hours after treatment,the levels of NT proBNP and copeptin in both groups of patients decreased,and the NT-proBNP levels in grade Ⅱ and Ⅲ patients in Group A[(3561.16±126)pg/ml,(4681.23±245.33)pg/ml]were higher than those in grade Ⅱ and Ⅲ patients in group B[(3026.59±145.27)pg/ml,(4126.89±275.46)pg/ml],while the NT-proBNP level in grade Ⅳ in Group A was lower than that in group B[(5149.56±312.05)pg/ml vs.(5463.29±345.71)pg/ml,P<0.05].Immediately after treatment,at the 6 and 24 hours,the levels of PaO2 and SaO2 in all the patients showed a trend of grade Ⅱ>grade Ⅲ>grade Ⅳ.Within 24 hours after treatment,the levels of PaO2 and SaO2 in all the patients showed an upward trend.At 24 hours after treatment,the PaO2 level in Group B's Grade Ⅳ patients was lower than that in Group A's Grade Ⅳ patients[(74.12±5.95)mmHg vs.(80.36±5.72)mmHg].At 6 hours and 24 hours after treatment,the SaO2 levels in Grade Ⅱ and Ⅲ of Group B were higher those that in Group A(P<0.05).A total of 9 patients(10.00%)underwent intubation in Group A,8 patients(8.89%)in Group B;3 patients(3.33%)died in Group A,and 2 patients(2.22%)died in Group B.There was no statistically significant difference in intubation rate and mortality rate between the two groups(P>0.05).Conclusion BiPAP has a better therapeutic effect on elderly patients with acute left heart failure and hypoxemia with cardiac function grading of Ⅳ,while HFNC has a better therapeutic effect on patients with cardiac function grading of Ⅱ and Ⅲ.In clinical practice,the classification of patients'cardiac function should be used as an auxiliary indicator to select treatment options.