Clinical study on the effect of high-flow nasal cannula oxygen therapy on nerve ventilation drive and respiratory work in patients with chronic obstructive pulmonary disease after mechanical ventilation extubation

Xi Xiaohong; Chen Meiqin; Zhu Lihua; Bao Lifeng; Li Junhua

doi:10.3760/j.issn.1673-4777.2024.06.007

Abstract：Objective To explore the effects of high-flow nasal cannula oxygen therapy(HFNC)on nerve ventilation drive and respiratory work in patients with chronic obstructive pulmonary disease(COPD)after mechanical ventilation extubation.Methods A total of 292 COPD patients who underwent mechanical ventilation and extubation in the Intensive Care Unit(ICU)and the Emergency Intensine Care Unit of People's Hospital of Quzhou,Zhejiang Province from January 2020 to June 2022 were selected and randomly divided into observation group and control group,with 146 cases in each group.The observation group received HFNC intervention,and the control group received Venturi mask oxygen therapy intervention.The general data of the two groups were compared.The respiratory parameters,blood gas analysis indexes,diaphragm electrical activity(EAdi)data and inspiratory effort index were compared between the two groups at the beginning of oxygen therapy and 30 min,60 min,24 h of oxygen therapy.The differences of clinical indicators between the two groups were compared.Results During the study period,7 and 5 patients were excluded from the control group and the observation group.After 60 min of oxygen therapy and 24 h of oxygen therapy,the respiratory rate and arterial partial pressure of carbon dioxide in the observation group were lower than those in the control group,and the oxygenation index and arterial oxygen partial pressure were higher than those in the control group(all P＜0.05).After 60 min of oxygen therapy and 24 h of oxygen therapy,the EAdi peak value,the EAdi valley value,the area under the EAdi curve,the product of diaphragmatic pressure-time,the product of diaphragmatic pressure-time per minute,and the product of diaphragmatic pressure-time per aspiration in the observation group were lower than those in the control group(all P＜0.05).The reintubation rate within 48 h,ICU hospitalization cost and ICU hospitalization time in the observation group were lower/shorter than those in the control group[6.4％(9/141)vs 18.7％(26/139),(43±8)thousand yuan vs(61±11)thousand yuan,(5.7±1.1)d vs(7.8±1.3)d](all P＜0.05).Conclusion Compared with traditional oxygen therapy,HFNC can effectively improve the neural ventilation drive and respiratory work of COPD patients after mechanical ventilation extubation,reduce the reintubation rate,shorten the length of ICU stay,and reduce the treatment cost.