High-flow nasal cannula oxygen therapy and noninvasive ventilation for preventing extubation failure during weaning from mechanical ventilation assessed by lung ultrasound score: A single-center randomized study

作     者：Shan-xiang Xu Chun-shuang Wu Shao-yun Liu Xiao Lu Shan-xiang Xu;Chun-shuang Wu;Shao-yun Liu;Xiao Lu

作者机构：Emergency Departmentthe Second Affi liated Hospital of Zhejiang University School of MedicineHangzhou 310009China 

出 版 物：《World Journal of Emergency Medicine》 (世界急诊医学杂志（英文）)

年 卷 期：2021年第12卷第4期

页      面：274-280页

核心收录：

学科分类：100218[医学-急诊医学] 1002[医学-临床医学] 1010[医学-医学技术（可授医学、理学学位）] 10[医学] 

主　　题：High-flow nasal cannula oxygen Noninvasive ventilation Lung ultrasound Extubation 

摘      要：BACKGROUND: We sought to demonstrate the superiority of a targeted therapy strategy involving high-flow nasal cannula oxygen(HFNCO_(2)) therapy and noninvasive ventilation(NIV) using lung ultrasound score(LUS) in comparison with standard care among patients in the intensive care unit(ICU) who undergo successful weaning to decrease the incidence of extubation failure at both 48 hours and seven ***: During the study period, 98 patients were enrolled in the study, including 49 in the control group and 49 in the treatment group. Patients in the control group and patients with an LUS score 14 points(at low risk of extubation failure) in the treatment group were extubated and received standard preventive care without NIV or HFNCO_(2). Patients with an LUS score ≥14 points(at high risk of extubation failure) in the treatment group were extubated with a second review of the therapeutic optimization to identify and address any persisting risk factors for postextubation respiratory distress;patients received HFNCO2 therapy combined with sessions of preventive NIV(4-8 hours per day for 4-8 sessions total) for the first 48 hours after ***: In the control group, 13 patients had the LUS scores ≥14 points, while 36 patients had scores 14 points. In the treatment group, 16 patients had the LUS scores ≥14 points, while 33 patients had scores 14 points. Among patients with the LUS score ≥14 points, the extubation failure rate within 48 hours was 30.8% in the control group and 12.5% in the treatment group, constituting a statistically significant difference(P0.05). Conversely, among patients with an LUS score 14 points, 13.9% in the control group and 9.1% in the treatment group experienced extubation failure(P=0.61). The length of ICU stay(9.4±3.1 days vs. 7.2±2.4 days) was significantly different and the re-intubation rate(at 48 hours: 18.4% vs. 10.2%;seven days: 22.4% vs. 12.2%) significantly varied between the two groups(P0.05). There was no significan