Zhonghua wei zhong bing ji jiu yi xue · 2025
[Effect of noninvasive positive pressure ventilation by face mask versus nasal high-flow humidified oxygen therapy on the rate of endotracheal intubation in patients with acute respiratory distress syndrome due to viral pneumonia].
СтатьяСравнительное исследованиеАннотация на английскомНазвание и аннотация: Перевод пока не подготовлен
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Shen Jie, Wei Cunxiong, Wu Xue, Wan Qiufeng, Li Jingwen, Wang Caixia, Guo Zhijin, Caikai Shareli, Xu Sicheng
Аннотация
OBJECTIVE: To compare the impact of noninvasive positive pressure ventilation (NPPV) by face mask versus high-flow nasal cannula (HFNC) oxygen therapy on the endotracheal intubation rate in patients with acute respiratory distress syndrome (ARDS) caused by viral pneumonia.
METHODS: A retrospective study was conducted. ARDS patients with viral pneumonia were treated in the respiratory intensive care unit (RICU) of the First Affiliated Hospital of Xinjiang Medical University from January 1, 2023 to December 31, 2024, and they were divided into NPPV group and HFNC group according to initial respiratory support methods, with matching for the number of patients with moderate-to-severe ARDS. The primary endpoint was endotracheal intubation. Baseline data including demographic characteristics, vital signs, disease severity, underlying diseases, and types of infecting viruses at admission were compared between the two groups. Changes in respiratory support indicators at 24 hours and 72 hours of treatment, related complications, endotracheal intubation rate, the length of RICU stay and mortality were also compared.
RESULTS: A total of 205 patients were enrolled, with 104 in the NPPV group and 101 in the HFNC group. There were no statistically significant differences in gender, age, vital signs, disease severity, underlying diseases, and types of infecting viruses between the two groups (all P > 0.05), indicating that the two groups were comparable. Compared to the HFNC group, the NPPV group showed more significant reductions in heart rate (HR) and respiratory rate (RR) at both 24 hours and 72 hours of treatment [change in HR (ΔHR, bpm) at 24 hours, 72 hours: -29.00 (-42.00, -16.00) vs. -23.00 (-37.00, -6.00), -36.83±19.06 vs. -28.29±19.53; change in RR (ΔRR, bpm): -7.6±5.8 vs. -5.0±4.8, -9.5 (-13.0, -5.0) vs. -8.0 (-10.0, -4.0)], and a more marked increase in the oxygenation index (PaO2/FiO2) [change in PaO2/FiO2 (ΔPaO2/FiO2, mmHg, 1 mmHg = 0.133 kPa ): 43.0 (5.0, 76.0) vs. 23.0 (-2.0, 46.0), 60.6±77.7 vs. 38.7±67.6], all differences were statistically significant (all P < 0.05). Compared with the HFNC group, the NPPV group showed a significant decrease in endotracheal intubation rate [25.0% (26/104) vs. 38.6% (39/101), P < 0.05], so did in patients over 65 years old [27.8% (20/72) vs. 45.2% (33/73), P < 0.05]. The incidence of complications such as aspiration, abdominal distension, nasal and facial skin lesions, and intolerance in the NPPV group was significantly higher than that in the HFNC group [30.8% (32/104) vs. 5.9% (6/101), P < 0.05], and the length of RICU stay was significantly shortened [days: 10.0 (7.0, 14.5) vs. 14.0 (9.0, 20.0), P < 0.05], however, there was no significant difference in mortality [13.5% (14/104) vs. 16.8% (17/101), P > 0.05].
CONCLUSIONS: For patients with ARDS due to viral pneumonia, NPPV significantly reduces the endotracheal intubation rate when compared with HFNC, particularly in elderly patients, but does not reduce mortality.
METHODS: A retrospective study was conducted. ARDS patients with viral pneumonia were treated in the respiratory intensive care unit (RICU) of the First Affiliated Hospital of Xinjiang Medical University from January 1, 2023 to December 31, 2024, and they were divided into NPPV group and HFNC group according to initial respiratory support methods, with matching for the number of patients with moderate-to-severe ARDS. The primary endpoint was endotracheal intubation. Baseline data including demographic characteristics, vital signs, disease severity, underlying diseases, and types of infecting viruses at admission were compared between the two groups. Changes in respiratory support indicators at 24 hours and 72 hours of treatment, related complications, endotracheal intubation rate, the length of RICU stay and mortality were also compared.
RESULTS: A total of 205 patients were enrolled, with 104 in the NPPV group and 101 in the HFNC group. There were no statistically significant differences in gender, age, vital signs, disease severity, underlying diseases, and types of infecting viruses between the two groups (all P > 0.05), indicating that the two groups were comparable. Compared to the HFNC group, the NPPV group showed more significant reductions in heart rate (HR) and respiratory rate (RR) at both 24 hours and 72 hours of treatment [change in HR (ΔHR, bpm) at 24 hours, 72 hours: -29.00 (-42.00, -16.00) vs. -23.00 (-37.00, -6.00), -36.83±19.06 vs. -28.29±19.53; change in RR (ΔRR, bpm): -7.6±5.8 vs. -5.0±4.8, -9.5 (-13.0, -5.0) vs. -8.0 (-10.0, -4.0)], and a more marked increase in the oxygenation index (PaO2/FiO2) [change in PaO2/FiO2 (ΔPaO2/FiO2, mmHg, 1 mmHg = 0.133 kPa ): 43.0 (5.0, 76.0) vs. 23.0 (-2.0, 46.0), 60.6±77.7 vs. 38.7±67.6], all differences were statistically significant (all P < 0.05). Compared with the HFNC group, the NPPV group showed a significant decrease in endotracheal intubation rate [25.0% (26/104) vs. 38.6% (39/101), P < 0.05], so did in patients over 65 years old [27.8% (20/72) vs. 45.2% (33/73), P < 0.05]. The incidence of complications such as aspiration, abdominal distension, nasal and facial skin lesions, and intolerance in the NPPV group was significantly higher than that in the HFNC group [30.8% (32/104) vs. 5.9% (6/101), P < 0.05], and the length of RICU stay was significantly shortened [days: 10.0 (7.0, 14.5) vs. 14.0 (9.0, 20.0), P < 0.05], however, there was no significant difference in mortality [13.5% (14/104) vs. 16.8% (17/101), P > 0.05].
CONCLUSIONS: For patients with ARDS due to viral pneumonia, NPPV significantly reduces the endotracheal intubation rate when compared with HFNC, particularly in elderly patients, but does not reduce mortality.