The comparative study of high-flow nasal cannula oxygen therapy and non-invasive ventilation in treatment of acute respiratory distress syndrome induced by severe coronavirus disease 2019_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

WANG Chaoping ¹ , HUANG Xiuli ² , LUO Xiaobin ¹ , WU Xiaojuan ¹ , HAN Shuqing ³ , LIN Zhengze ⁴ ,  HE Zhengguang ⁵

1. Department of Respiratory and Critical Care Medicine, Suining Central Hospital, Suining, Sichuan 629000, P. R. China;
2. Department of Endocrinology and Metabolism, Suining Central Hospital, Suining, Sichuan 629000, P. R. China;
3. Department of Neurosurgery, Wuhan Red Cross Hospital, Wuhan, Hubei 430015, P. R. China;
4. Department of Critical Care Medicine, Suining Central Hospital, Suining, Sichuan 629000, P. R. China;
5. Department of Respiratory and Critical Care Medicine, Suining Third People’s Hospital, Suining, Sichuan 629000, P. R. China;

Corresponding?author：

HE Zhengguang, Email: xnwcp2010@163.com

Keywords：

Corona virus disease 2019; Acute respiratory distress syndrome; High-flow nasal cannula oxygen therapy; Non-invasive ventilation

DOI：

10.7507/1671-6205.202006015

Video：

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Objective To compare the clinical efficacy and safety of high-flow nasal cannula oxygen therapy (HFNC) and non-invasive ventilation (NIV) in treatment of acute respiratory distress syndrome (ARDS) induced by coronavirus disease 2019 (COVID-19). Methods Sixty-eight patients with ARDS induced by COVID-19 in Wuhan Concorde Red Cross Hospital form January 25, 2020 to March 10, 2020 were included in the study. They were divided into an HFNC group (n=36) and an NIV group (n=36) according to the treatment. All patients received basic routine treatment, antiviral treatment and prevention therapy of secondary infection. The HFNC group received high-flow nasal cannula oxygen therapy, and the NIV group received NIV therapy. Then respiration and circulation parameters, comfort and tolerance, complications were compared between the two groups. Results After treatment for 3 days, 1 week, and 2 weeks in all patients with COVID-19 induced ARDS, respiratory rate (RR) was lower than that before therapy, arterial partial pressure of oxygen (PaO₂), pulse oxygen saturation (SpO₂), PaO₂/FiO₂ were higher than those before therapy (P<0.05), and therapeutic effect was time-dependent. But there was no significant difference of RR, PaO₂, SpO₂, PaO₂/FiO₂ between the HFNC group and the NIV group at different time points (P>0.05). After treatment for 2 weeks, the HFNC group patients' comfort, difficulty breathing, tolerance score were lower than the NIV group (P<0.05, P<0.01), the incidence rate of gastric distension and dry mouth etc. was lower than that in the NIV group (11.11% vs. 37.50%, P<0.05). There was no significant difference in rate of invasive mechanical ventilation or mortality between the two groups (P>0.05). Conclusions HFNC and NIV can improve respiratory and circulatory parameters of patients with COVID-19 induced ARDS. HFNC has better comfort and tolerance, and can reduce related complications.

Citation： WANG Chaoping, HUANG Xiuli, LUO Xiaobin, WU Xiaojuan, HAN Shuqing, LIN Zhengze, HE Zhengguang. The comparative study of high-flow nasal cannula oxygen therapy and non-invasive ventilation in treatment of acute respiratory distress syndrome induced by severe coronavirus disease 2019. Chinese Journal of Respiratory and Critical Care Medicine, 2022, 21(1): 20-24. doi: 10.7507/1671-6205.202006015 Copy

1.	Xu Z, Shi L, Wang YJ, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Res Med, 2020, 22(8): 420-422.
2.	中華醫學會呼吸病學會呼吸危重癥醫學學組. 急性呼吸窘迫綜合征患者機械通氣指南(試行). 中華醫學雜志, 2016, 96(6): 404-424.
3.	Cinesi Gomez C, Penuelas Rodrlguez O, et al. Clinical consensus recommendations regarding non-invasive respiratory support in the adult patient with acute respiratory failure secondary to SARS-CoV-2 infection. Med Intensiva (Engl Ed), 2020, 44(7): 429-438.
4.	Tinelli V, Cabrini L, Fominskiy E, et al. High flow nasal cannula oxygen vs. conventional oxygen therapy and noninvasive ventilation in emergency department patients: a systematic review and meta-analysis. J Emerg Med, 2019, 57(3): 322-328.
5.	陸洋, 沈浩亮, 劉向新, 等. 重癥急性胰腺炎合并急性呼吸窘迫綜合征經鼻高流量氧療治療失敗的相關危險因素分析. 東南大學學報(醫學版), 2018, 37(6): 951-956.
6.	Roca O, Messika J, Caralt B, et al. Predicting success of high flow nasal cannula in pneumonia patients with hypoxemic respiratory failure: the utility of the ROX index. J Cirt Care, 2016, 35: 200-205.
7.	倪忠, 秦浩, 李潔, 等; 中華醫學會呼吸病學分會呼吸治療學組. 新型冠狀病毒肺炎患者經鼻高流量氧療使用管理專家共識. 中國呼吸與危重監護雜志, 2020, 19(2): 110-115.
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9.	ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, Thompson BT, et al. Acute respiratory distress syndrome: the Berlin definition. JAMA, 2012, 307(23): 2526-2533.
10.	Tiruvoipati R, Lewis D, Haji K, et al. High-flow nasal oxygen vs high-flow face mask: a randomized crossover trial in extubated patients. J Crit Care, 2010, 25(3): 463-468.
11.	Huang CL, Wang YM, Li XW, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet, 2020, 395(10223): 497-506.
12.	李遠征, 李銳, 李春雨, 等. 新型冠狀病毒肺炎危重癥患者的呼吸支持及管理策略. 長治醫學院學報, 2020, 34(1): 18-21.
13.	Beng Leong L, Wei Ming N, Wei Feng L. High flow nasal cannula oxygen versus noninvasive ventilation in adult acute respiratory failure: a systematic review of randomized-controlled trials. Eur J Eemerg Med, 2019, 26(1): 9-18.
14.	朱慶程, 曹鵬, 談定玉, 等. 經鼻高流量氧療與無創機械通氣治療創傷相關肺損傷的療效比較. 實用臨床醫藥雜志, 2019, 23(23): 20-23.
15.	王健, 馬新華, 李莉, 等. 經鼻高流量氧療治療Ⅰ型呼吸衰竭的療效分析. 中國現代醫學雜志, 2018, 28(14): 65-70.
16.	談定玉, 凌冰玉, 孫家艷, 等. 經鼻高流量氧療與無創正壓通氣比較治療慢性阻塞性肺疾病合并中度呼吸衰竭的觀察性隊列研究. 中華急診醫學雜志, 2018, 27(4): 361-366.
17.	Panadero C, Abad-Fernández A, Rio-Ramirez MT, et al. High-flow nasal cannula for acute respiratory distress syndrome (ARDS) due to COVID-19. Multidiscip Respir Med, 2020, 15(1): 693.
18.	Suffredini DA, Allison MG. A rationale for use of high flow nasal cannula for select patients with suspected or confirmed severe acute respiratory syndrome coronavirus-2 infection. J Intensive Care Med, 2021, 36(1): 9-17.
19.	馬德勝, 羅書航, 馬莉, 等. 經鼻高流量氧療在急性呼吸窘迫綜合征的臨床實踐進展. 臨床肺科雜志, 2020, 25(5): 785-788.
20.	Hill NS, Ruthazer R. Predicting outcomes of high-flow nasal cannula for acute respiratory distress syndrome. An Index that ROX. Am J Respir Crit Med, 2019, 199(11): 1300-1302.
21.	李雯莉, 孫虎, 李丹丹, 等. 高流量氧療與無創正壓通氣對呼衰患者的影響. 中華急診醫學雜志, 2018, 27(4): 381-383.

1. Xu Z, Shi L, Wang YJ, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Res Med, 2020, 22(8): 420-422.
2. 中華醫學會呼吸病學會呼吸危重癥醫學學組. 急性呼吸窘迫綜合征患者機械通氣指南(試行). 中華醫學雜志, 2016, 96(6): 404-424.
3. Cinesi Gomez C, Penuelas Rodrlguez O, et al. Clinical consensus recommendations regarding non-invasive respiratory support in the adult patient with acute respiratory failure secondary to SARS-CoV-2 infection. Med Intensiva (Engl Ed), 2020, 44(7): 429-438.
4. Tinelli V, Cabrini L, Fominskiy E, et al. High flow nasal cannula oxygen vs. conventional oxygen therapy and noninvasive ventilation in emergency department patients: a systematic review and meta-analysis. J Emerg Med, 2019, 57(3): 322-328.
5. 陸洋, 沈浩亮, 劉向新, 等. 重癥急性胰腺炎合并急性呼吸窘迫綜合征經鼻高流量氧療治療失敗的相關危險因素分析. 東南大學學報(醫學版), 2018, 37(6): 951-956.
6. Roca O, Messika J, Caralt B, et al. Predicting success of high flow nasal cannula in pneumonia patients with hypoxemic respiratory failure: the utility of the ROX index. J Cirt Care, 2016, 35: 200-205.
7. 倪忠, 秦浩, 李潔, 等; 中華醫學會呼吸病學分會呼吸治療學組. 新型冠狀病毒肺炎患者經鼻高流量氧療使用管理專家共識. 中國呼吸與危重監護雜志, 2020, 19(2): 110-115.
8. 國家衛生健康委辦公廳, 國家中醫藥管理局辦公室. 關于印發新型冠狀病毒感染的肺炎診療方案(試行第五版). 國衛辦醫函[2020]103號.
9. ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, Thompson BT, et al. Acute respiratory distress syndrome: the Berlin definition. JAMA, 2012, 307(23): 2526-2533.
10. Tiruvoipati R, Lewis D, Haji K, et al. High-flow nasal oxygen vs high-flow face mask: a randomized crossover trial in extubated patients. J Crit Care, 2010, 25(3): 463-468.
11. Huang CL, Wang YM, Li XW, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet, 2020, 395(10223): 497-506.
12. 李遠征, 李銳, 李春雨, 等. 新型冠狀病毒肺炎危重癥患者的呼吸支持及管理策略. 長治醫學院學報, 2020, 34(1): 18-21.
13. Beng Leong L, Wei Ming N, Wei Feng L. High flow nasal cannula oxygen versus noninvasive ventilation in adult acute respiratory failure: a systematic review of randomized-controlled trials. Eur J Eemerg Med, 2019, 26(1): 9-18.
14. 朱慶程, 曹鵬, 談定玉, 等. 經鼻高流量氧療與無創機械通氣治療創傷相關肺損傷的療效比較. 實用臨床醫藥雜志, 2019, 23(23): 20-23.
15. 王健, 馬新華, 李莉, 等. 經鼻高流量氧療治療Ⅰ型呼吸衰竭的療效分析. 中國現代醫學雜志, 2018, 28(14): 65-70.
16. 談定玉, 凌冰玉, 孫家艷, 等. 經鼻高流量氧療與無創正壓通氣比較治療慢性阻塞性肺疾病合并中度呼吸衰竭的觀察性隊列研究. 中華急診醫學雜志, 2018, 27(4): 361-366.
17. Panadero C, Abad-Fernández A, Rio-Ramirez MT, et al. High-flow nasal cannula for acute respiratory distress syndrome (ARDS) due to COVID-19. Multidiscip Respir Med, 2020, 15(1): 693.
18. Suffredini DA, Allison MG. A rationale for use of high flow nasal cannula for select patients with suspected or confirmed severe acute respiratory syndrome coronavirus-2 infection. J Intensive Care Med, 2021, 36(1): 9-17.
19. 馬德勝, 羅書航, 馬莉, 等. 經鼻高流量氧療在急性呼吸窘迫綜合征的臨床實踐進展. 臨床肺科雜志, 2020, 25(5): 785-788.
20. Hill NS, Ruthazer R. Predicting outcomes of high-flow nasal cannula for acute respiratory distress syndrome. An Index that ROX. Am J Respir Crit Med, 2019, 199(11): 1300-1302.
21. 李雯莉, 孫虎, 李丹丹, 等. 高流量氧療與無創正壓通氣對呼衰患者的影響. 中華急診醫學雜志, 2018, 27(4): 381-383.

Chinese Journal of Respiratory and Critical Care Medicine

The comparative study of high-flow nasal cannula oxygen therapy and non-invasive ventilation in treatment of acute respiratory distress syndrome induced by severe coronavirus disease 2019

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