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[Effect of noninvasive positive pressure ventilation and high-flow nasal cannula oxygen therapy on the clinical efficacy of coronavirus disease 2019 patients with acute respiratory distress syndrome].
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2021 Jun; 33(6):708-713.ZW

Abstract

OBJECTIVE

To observe the effect of noninvasive positive pressure ventilation (NIPPV) and high-flow nasal cannula oxygen therapy (HFNC) on the prognosis of patients with coronavirus disease 2019 (COVID-19) accompanied with acute respiratory distress syndrome (ARDS).

METHODS

A retrospective study was conducted in Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology when authors worked as medical team members for treating COVID-19. COVID-19 patients with pulse oxygen saturation/fraction of inspiration oxygen (SpO2/FiO2, S/F) ratio < 235, managed by medical teams [using S/F ratio instead of oxygenation index (PaO2/FiO2) to diagnose ARDS] from February to April 2020 were included. The patients were divided into NIPPV group and HFNC group according to their oxygen therapy modes. Clinical data of patients were collected, including general characteristics, respiratory rate (RR), fraction of FiO2, SpO2, heart rate (HR), mean arterial pressure (MAP), S/F ratio in the first 72 hours, lymphocyte count (LYM), percentage of lymphocyte (LYM%) and white blood cell count (WBC) at admission and discharge or death, the duration of dyspnea before NIPPV and HFNC, and the length from onset to admission. The differences of intubation rate, all-cause mortality, S/F ratio and RR were analyzed, and single factor analysis and generalized estimation equation (GEE) were used to analyze the risk factors affecting S/F ratio.

RESULTS

Among the 41 patients, the proportion of males was high (68.3%, 28 cases), the median age was 68 (58-74) years old, 28 cases had complications (68.3%), and 34 cases had multiple organ dysfunction syndrome (MODS, 82.9%). Compared with HFNC group, the proportion of complications in NIPPV group was higher [87.5% (21/24) vs. 41.2% (7/17), P < 0.05], and the value of LYM% was lower [5.3% (3.4%-7.8%) vs. 10.0% (3.9%-19.7%), P < 0.05], the need of blood purification was also significantly lower [0% (0/24) vs. 29.4% (5/17), P < 0.05]. The S/F ratio of NIPPV group gradually increased after 2 hours treatment and RR gradually decreased with over time, S/F ratio decreased and RR increased in HFNC group compared with baseline, but there was no significant difference in S/F ratio between the two groups at each time point. RR in NIPPV group was significantly higher than that in HFNC group after 2 hours treatment [time/min: 30 (27-33) vs. 24 (21-27), P < 0.05]. There was no significant difference in rate need intubation and hospital mortality between NIPPV group and HFNC group [66.7% (16/24) vs. 70.6% (12/17), 58.3% (14/24) vs. 52.9% (9/17), both P > 0.05]. Analysis of the factors affecting the S/Fratio in the course of oxygen therapy showed that the oxygen therapy mode and the course of illness at admission were the factors affecting the S/F ratio of patients [βvalues were -15.827, 1.202, 95% confidence interval (95%CI) were -29.102 to -2.552 and 0.247-2.156, P values were 0.019 and 0.014, respectively].

CONCLUSIONS

Compared with HFNC, NIPPV doesn't significantly reduce the intubation rate and mortality of patients with COVID-19 accompanied with ARDS, but it significantly increases the S/F ratio of those patients.

Authors+Show Affiliations

Department of Intensive Care Unit, Peking University Third Hospital, Beijing 100191, China.Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei, China.Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing 100191, China.Department of Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing 100191, China.Department of General Surgery, Peking University Third Hospital, Beijing 100191, China.Department of Intensive Care Unit, Peking University Third Hospital, Beijing 100191, China.Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing 100191, China.Department of Cardiology, Peking University Third Hospital, Beijing 100191, China.Department of Institute of Sports Medicine, Peking University Third Hospital, Beijing 100191, China.Department of Thoracic Surgery, Peking University Third Hospital, Beijing 100191, China.Department of Institute of Sports Medicine, Peking University Third Hospital, Beijing 100191, China.Department of Neurosurgery, Peking University Third Hospital, Beijing 100191, China.Department of Orthopedics, Peking University Third Hospital, Beijing 100191, China. Corresponding author: Ge Qinggang, Email: qingganggelin@126.com.Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing 100191, China.Department of Intensive Care Unit, Peking University Third Hospital, Beijing 100191, China.

Pub Type(s)

Journal Article

Language

chi

PubMed ID

34296691

Citation

Zhao, Zhiling, et al. "[Effect of Noninvasive Positive Pressure Ventilation and High-flow Nasal Cannula Oxygen Therapy On the Clinical Efficacy of Coronavirus Disease 2019 Patients With Acute Respiratory Distress Syndrome]." Zhonghua Wei Zhong Bing Ji Jiu Yi Xue, vol. 33, no. 6, 2021, pp. 708-713.
Zhao Z, Cao H, Cheng Q, et al. [Effect of noninvasive positive pressure ventilation and high-flow nasal cannula oxygen therapy on the clinical efficacy of coronavirus disease 2019 patients with acute respiratory distress syndrome]. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2021;33(6):708-713.
Zhao, Z., Cao, H., Cheng, Q., Li, N., Zhang, S., Ge, Q., Shen, N., Yang, L., Shi, W., Bai, J., Meng, Q., Wu, C., Wang, B., Li, Q., & Yao, G. (2021). [Effect of noninvasive positive pressure ventilation and high-flow nasal cannula oxygen therapy on the clinical efficacy of coronavirus disease 2019 patients with acute respiratory distress syndrome]. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue, 33(6), 708-713. https://doi.org/10.3760/cma.j.cn121430-20210104-00002
Zhao Z, et al. [Effect of Noninvasive Positive Pressure Ventilation and High-flow Nasal Cannula Oxygen Therapy On the Clinical Efficacy of Coronavirus Disease 2019 Patients With Acute Respiratory Distress Syndrome]. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2021;33(6):708-713. PubMed PMID: 34296691.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Effect of noninvasive positive pressure ventilation and high-flow nasal cannula oxygen therapy on the clinical efficacy of coronavirus disease 2019 patients with acute respiratory distress syndrome]. AU - Zhao,Zhiling, AU - Cao,Hong, AU - Cheng,Qin, AU - Li,Nan, AU - Zhang,Shuisheng, AU - Ge,Qinggang, AU - Shen,Ning, AU - Yang,Lincheng, AU - Shi,Weili, AU - Bai,Jie, AU - Meng,Qingyang, AU - Wu,Chao, AU - Wang,Ben, AU - Li,Qiuyu, AU - Yao,Gaiqi, PY - 2021/7/23/entrez PY - 2021/7/24/pubmed PY - 2021/7/27/medline SP - 708 EP - 713 JF - Zhonghua wei zhong bing ji jiu yi xue JO - Zhonghua Wei Zhong Bing Ji Jiu Yi Xue VL - 33 IS - 6 N2 - OBJECTIVE: To observe the effect of noninvasive positive pressure ventilation (NIPPV) and high-flow nasal cannula oxygen therapy (HFNC) on the prognosis of patients with coronavirus disease 2019 (COVID-19) accompanied with acute respiratory distress syndrome (ARDS). METHODS: A retrospective study was conducted in Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology when authors worked as medical team members for treating COVID-19. COVID-19 patients with pulse oxygen saturation/fraction of inspiration oxygen (SpO2/FiO2, S/F) ratio < 235, managed by medical teams [using S/F ratio instead of oxygenation index (PaO2/FiO2) to diagnose ARDS] from February to April 2020 were included. The patients were divided into NIPPV group and HFNC group according to their oxygen therapy modes. Clinical data of patients were collected, including general characteristics, respiratory rate (RR), fraction of FiO2, SpO2, heart rate (HR), mean arterial pressure (MAP), S/F ratio in the first 72 hours, lymphocyte count (LYM), percentage of lymphocyte (LYM%) and white blood cell count (WBC) at admission and discharge or death, the duration of dyspnea before NIPPV and HFNC, and the length from onset to admission. The differences of intubation rate, all-cause mortality, S/F ratio and RR were analyzed, and single factor analysis and generalized estimation equation (GEE) were used to analyze the risk factors affecting S/F ratio. RESULTS: Among the 41 patients, the proportion of males was high (68.3%, 28 cases), the median age was 68 (58-74) years old, 28 cases had complications (68.3%), and 34 cases had multiple organ dysfunction syndrome (MODS, 82.9%). Compared with HFNC group, the proportion of complications in NIPPV group was higher [87.5% (21/24) vs. 41.2% (7/17), P < 0.05], and the value of LYM% was lower [5.3% (3.4%-7.8%) vs. 10.0% (3.9%-19.7%), P < 0.05], the need of blood purification was also significantly lower [0% (0/24) vs. 29.4% (5/17), P < 0.05]. The S/F ratio of NIPPV group gradually increased after 2 hours treatment and RR gradually decreased with over time, S/F ratio decreased and RR increased in HFNC group compared with baseline, but there was no significant difference in S/F ratio between the two groups at each time point. RR in NIPPV group was significantly higher than that in HFNC group after 2 hours treatment [time/min: 30 (27-33) vs. 24 (21-27), P < 0.05]. There was no significant difference in rate need intubation and hospital mortality between NIPPV group and HFNC group [66.7% (16/24) vs. 70.6% (12/17), 58.3% (14/24) vs. 52.9% (9/17), both P > 0.05]. Analysis of the factors affecting the S/Fratio in the course of oxygen therapy showed that the oxygen therapy mode and the course of illness at admission were the factors affecting the S/F ratio of patients [βvalues were -15.827, 1.202, 95% confidence interval (95%CI) were -29.102 to -2.552 and 0.247-2.156, P values were 0.019 and 0.014, respectively]. CONCLUSIONS: Compared with HFNC, NIPPV doesn't significantly reduce the intubation rate and mortality of patients with COVID-19 accompanied with ARDS, but it significantly increases the S/F ratio of those patients. SN - 2095-4352 UR - https://www.unboundmedicine.com/medline/citation/34296691/[Effect_of_noninvasive_positive_pressure_ventilation_and_high_flow_nasal_cannula_oxygen_therapy_on_the_clinical_efficacy_of_coronavirus_disease_2019_patients_with_acute_respiratory_distress_syndrome]_ L2 - https://www.diseaseinfosearch.org/result/210 DB - PRIME DP - Unbound Medicine ER -