Effect of high-flow nasal cannula oxygen therapy in prone position on improving transpulmonary pressure in patients with acute respiratory distress syndrome
Objective To investigate the role of high-flow nasal cannula oxygen therapy in prone position in improving oxygenation and transpulmonary pressure in patients with acute respiratory distress syndrome(ARDS).Methods From January 2016 to December 2019,46 patients with mild to moderate ARDS underwent high-flow nasal cannula oxygen therapy in Henan Provincial People's Hospital,among whom 23 patients received treatment in prone position(observation group)and another 23 patients received treatment in supine or lateral position(control group).After admission,both groups were given conventional treatment according to their serverity of disease,including anti-infection,treatment of primary disease and airway management to ensure hemodynamic and internal environmental stability,and administrations of small doses of glucocorticoids and neutrophil elastase inhibitors to treat ARDS.After starting ventilation,an esophageal pressure measurement tube was inserted through the nasal cavity to detect esophageal and airway pressures,and the end-inspiratory transpulmonary pressure,end-expiratory transpulmonary pressure,and transpulmonary driving pressure were calculated 12 and 24 h after starting ventilation.Lung electrical impedance tomography was used to monitor the mechanical power in non-gravitational dependent and gravitational dependent lung regions 12 and 24 h after starting ventilation.The clinical data as etiology,degree of ARDS and Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE IJ)were compared between two groups,and pa(O2),pa(CO2)and oxygenation index were recorded 12 and 24 h after starting ventilation.Results(1)There were no significant differences in the male ratio,proportion of moderate ARDS,age,etiology,admission APACHEⅡ score and drugs for ARDS between two groups(P＞0.05).(2)The values of pa(O2),oxygenation indexes,mechanical power values in gravitational dependent lung region were higher in observation group[(62.01±2.66),(64.68±2.87)mmHg;(141.69±7.98),(159.83±11.87)mmHg;(5.56± 0.59),(7.56±0.94)mJ]than those in control group[(60.05±4.51),(62.44±2.35)mmHg;(135.05±8.53),(139.62±12.63)mmHg;(3.92±0.56),(4.70±0.67)mJ]12 and 24 h after starting ventilation(P＜0.05),the values of pa(CO2),end-inspiratory transpulmonary pressures,end-expiratory transpulmonary pressures and transpulmonary driving pressures were lower in observation group[(44.07±2.87),(41.73±2.87)mmHg;(11.26± 1.98),(6.77±1.77)cmH2O;(1.58±0.30),(-1.88±0.66)cmH2O;(8.55±2.19),(7.44±1.84)cmH2O]than those in control group[(49.45±2.66),(48.30±2.50)mmHg;(12.98±1.96),(10.40±2.40)cmH2O;(1.98± 0.60),(-1.59±0.18)cmH2O;(11.77±2.71),(10.49±2.37)cmH2O](P＜0.05),and there were no significant differences in the mechanical power values in non-gravitational dependent lung region between two groups(P＞0.05).In both groups,the improvements in pa(O2)and pa(CO2),oxygenation indexes,end-inspiratory transpulmonary pressures,end-expiratory transpulmonary pressures,transpulmonary driving pressures,and mechanical power values in gravitational dependent lung region were better 24 h after starting ventilation than those 12 h after starting ventilation(P＜0.05),and there were no significant differences in mechanical power values in non-gravitational dependent lung region 24 h after starting ventilation compared with those 12 h after starting ventilation(P＞0.05).Conclusion High-flow nasal cannula oxygen therapy in the prone position can improve oxygenation,reduce thoracic pressure differences,and facilitate ventilation in the gravitational dependent lung region in patients with mild to moderate ARDS.
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