Effect of high-flow nasal cannula oxygen therapy on acute left heart failure

doi:10.3877/cma.j.issn.1674-6880.2019.01.005

Abstract

Abstract:

Objective

To study the therapeutic effect of high-flow nasal cannula oxygen therapy (HFNC) in patients with acute left heart failure.

Methods

From June 2016 to April 2018, 76 patients with acute left heart failure in the Department of Intensive Care Medicine, Sir Run Run Hospital, Nanjing Medical University were divided into the observation group (n= 38) and control group (n= 38). Patients in the control group were given routine treatment and patients in the observation group were given HFNC on the basis of control group. The partial pressure of arterial oxygen(PaO₂), partial pressure of arterial carbon dioxide(PaCO₂), arterial oxygen saturation (SaO₂), heart rate, respiratory rate, left ventricular ejection fraction (LVEF), stroke volume (SV), and N-terminal pro-brain natriuretic peptide (NT-proBNP) of these two groups were observed at 2, 6, 12 and 24 hours after treatment. The tracheal intubation rate, 28-day mortality and ICU stay in the two groups were compared.

Results

There were significant differences in PaO₂, PaCO₂, SaO₂, heart rate, respiratory rate, LVEF, SV and NT-proBNP of patients with acute left heart failure between the two groups at each time point(F= 28.302, 18.402, 32.514, 24.510, 16.165, 23.452, 19.167, 30.424; all P < 0.05). Further pairwise comparison showed that PaO₂, SaO₂, LVEF and SV in the observation group were significantly higher (all P < 0.05), and the PaCO₂, heart rate, respiratory rate and NT-proBNP were significantly lower than those in the control group at each time point (all P < 0.05). There were significant differences in the PaO₂, PaCO₂, SaO₂, heart rate, respiratory rate, LVEF, SV and NT-proBNP of these two groups at 6 h, 12 h and 24 h compared with those in the same group at 2 h (all P < 0.05). There were significant differences in the PaO₂, PaCO₂, SaO₂, heart rate, respiratory rate, LVEF, SV and NT-proBNP of these two groups at 12 h and 24 h compared with those in the same group at 6 h (all P < 0.05). The tracheal intubation rate [7.89% (3/38) vs. 23.68% (9/38), χ²= 3.982, P= 0.026], 28 d mortality [2.63% (1/38) vs. 10.53% (4/38), χ²= 4.307, P= 0.011) and ICU stay [(6 ± 3) d vs. (10 ± 5) d, t= 2.654, P= 0.034] between the two groups were all statistically significantly different.

Conclusion

HFNC in the early stage can significantly improve oxygenation and cardiac functions, reduce tracheal intubation rate and mortality, shorten ICU stay, and improve prognosis in patients with acute left heart failure.

Key words: High-flow nasal cannula oxygen therapy, Acute left heart failure, Arterial blood gas, Left ventricular ejection fraction, Stroke volume

Xiang Xue, Jinghui Yang, Ling Jia, Jiao Chen, Jianqin Cai, Weixiao Xu, Ruijuan Guo, Wei Zhao. Effect of high-flow nasal cannula oxygen therapy on acute left heart failure[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2019, 12(01): 25-30.

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References 22

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组别	例数	年龄（岁）	性别比（例，男/女）	冠状动脉粥样硬化性心脏病[例（%）]	风湿性心脏病[例（%）]	高血压性心脏病[例（%）]	扩张型心肌病[例（%）]	急性心肌梗死[例（%）]	慢性肾功能不全[例（%）]
观察组	38	55 ± 17	21/17	18（47.37）	10（26.32）	5（13.16）	1（2.63）	3（7.89）	1（2.63）
对照组	38	54 ± 13	22/16	17（44.74）	8（21.05）	7（18.42）	1（2.63）	3（7.89）	2（5.26）
t/χ²值		1.682	2.150	3.462	1.235	3.146	2.284	2.526	3.477
P值		0.102	0.143	0.063	0.266	0.076	0.131	0.111	0.062
组别	例数	PaO₂（mmHg）	PaCO₂（mmHg）	SaO₂（mmHg）	心率（次/min）	呼吸频率（次/min）	LVEF（%）	SV（mL）	NT-proBNP（ng/L）
观察组	38	56 ± 14	40.5 ± 4.5	88 ± 5	95 ± 19	26 ± 12	46 ± 13	59 ± 17	1 153 ± 255
对照组	38	57 ± 12	41.3 ± 5.5	89 ± 6	98 ± 23	28 ± 10	46 ± 15	57 ± 15	1 206 ± 267
t/χ²值		1.843	1.358	0.961	1.082	1.745	1.273	1.544	2.023
P值		0.075	0.184	0.344	0.287	0.091	0.212	0.132	0.051

组别	例数	年龄（岁）	性别比（例，男/女）	冠状动脉粥样硬化性心脏病[例（%）]	风湿性心脏病[例（%）]	高血压性心脏病[例（%）]	扩张型心肌病[例（%）]	急性心肌梗死[例（%）]	慢性肾功能不全[例（%）]
观察组	38	55 ± 17	21/17	18（47.37）	10（26.32）	5（13.16）	1（2.63）	3（7.89）	1（2.63）
对照组	38	54 ± 13	22/16	17（44.74）	8（21.05）	7（18.42）	1（2.63）	3（7.89）	2（5.26）
t/χ²值		1.682	2.150	3.462	1.235	3.146	2.284	2.526	3.477
P值		0.102	0.143	0.063	0.266	0.076	0.131	0.111	0.062
组别	例数	PaO₂（mmHg）	PaCO₂（mmHg）	SaO₂（mmHg）	心率（次/min）	呼吸频率（次/min）	LVEF（%）	SV（mL）	NT-proBNP（ng/L）
观察组	38	56 ± 14	40.5 ± 4.5	88 ± 5	95 ± 19	26 ± 12	46 ± 13	59 ± 17	1 153 ± 255
对照组	38	57 ± 12	41.3 ± 5.5	89 ± 6	98 ± 23	28 ± 10	46 ± 15	57 ± 15	1 206 ± 267
t/χ²值		1.843	1.358	0.961	1.082	1.745	1.273	1.544	2.023
P值		0.075	0.184	0.344	0.287	0.091	0.212	0.132	0.051

组别	时间点	例数	PaO₂（mmHg）	PaCO₂（mmHg）	SaO₂（%）	心率（次/min）	呼吸频率（次/min）
观察组	2h	38	78 ± 13^a	38 ± 6^a	93 ± 6^a	96 ± 15^a	22 ± 9^a
	6 h	38	87 ± 10^ab	36 ± 7^ab	96 ± 7^ab	88 ± 17^ab	21 ± 8^ab
	12 h	38	92 ± 12^abc	34 ± 4^abc	97 ± 6^abc	83 ± 13^abc	19 ± 8^abc
	24 h	38	92 ± 13^abc	34 ± 6^abc	98 ± 8^abc	82 ± 10^abc	18 ± 6^abc
对照组	2h	38	70 ± 10	41 ± 5	91 ± 8	103 ± 18	26 ± 8
	6 h	38	76 ± 13^b	39 ± 7^b	93 ± 7^b	95 ±15^b	25 ± 8^b
	12 h	38	78 ± 9^bc	38 ± 6^bc	94 ± 6^bc	92 ± 13^bc	23 ± 7^bc
	24 h	38	80 ± 14^bc	38 ± 7^bc	95 ± 3^bc	91 ± 7^bc	22 ± 9^bc
F值			28.302	18.402	32.514	24.510	16.165
P值			< 0.001	0.002	< 0.001	< 0.001	0.004

组别	时间点	例数	PaO₂（mmHg）	PaCO₂（mmHg）	SaO₂（%）	心率（次/min）	呼吸频率（次/min）
观察组	2h	38	78 ± 13^a	38 ± 6^a	93 ± 6^a	96 ± 15^a	22 ± 9^a
	6 h	38	87 ± 10^ab	36 ± 7^ab	96 ± 7^ab	88 ± 17^ab	21 ± 8^ab
	12 h	38	92 ± 12^abc	34 ± 4^abc	97 ± 6^abc	83 ± 13^abc	19 ± 8^abc
	24 h	38	92 ± 13^abc	34 ± 6^abc	98 ± 8^abc	82 ± 10^abc	18 ± 6^abc
对照组	2h	38	70 ± 10	41 ± 5	91 ± 8	103 ± 18	26 ± 8
	6 h	38	76 ± 13^b	39 ± 7^b	93 ± 7^b	95 ±15^b	25 ± 8^b
	12 h	38	78 ± 9^bc	38 ± 6^bc	94 ± 6^bc	92 ± 13^bc	23 ± 7^bc
	24 h	38	80 ± 14^bc	38 ± 7^bc	95 ± 3^bc	91 ± 7^bc	22 ± 9^bc
F值			28.302	18.402	32.514	24.510	16.165
P值			< 0.001	0.002	< 0.001	< 0.001	0.004

组别	时间点	例数	LVEF（%）	SV（mL）	NT-proBNP（ng/L）
观察组	2h	38	52 ± 12^a	65 ± 13^a	985 ± 208^a
	6 h	38	58 ± 10^ab	72 ± 14^ab	776 ± 148^ab
	12 h	38	63 ± 10^abc	74 ± 12^abc	485 ± 165^abc
	24 h	38	63 ± 12^abc	75 ± 16^abc	432 ± 135^abc
对照组	2h	38	49 ± 11	62 ± 10	1 126 ± 225
	6 h	38	50 ± 13^b	65 ± 11^b	985 ± 187^b
	12 h	38	53 ± 10^bc	67 ± 13^bc	824 ± 176^bc
	24 h	38	54 ± 16^bc	69 ± 14^bc	785 ± 259^bc
F值			23.452	19.167	30.424
P值			0.001	0.003	< 0.001

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