Factors related to ineffectiveness of high flow nasal cannula oxygen therapy in patients with acute exacerbation of interstitial pneumonia with respiratory failure

doi:10.3877/cma.j.issn.1674-0785.2022.08.012

Abstract

Abstract:

Objective

To identify the factors related to ineffectiveness of high flow nasal cannula (HFNC) oxygen therapy in patients with acute exacerbation of interstitial pneumonia (AE-IP) with respiratory failure (RF).

Methods

A total of 136 patients with AE-IP and RF who underwent HFNC oxygen therapy at Baiyin First People's Hospital from August 2019 to August 2021 were selected as the research subjects. After one week of treatment, the therapeutic effects were observed. Based on the therapeutic effects, the patients were divided into either an ineffective group or an effective group. The data were compared between the two groups. Logistic regression analysis was performed to identify the factors related to ineffectiveness of HFNC oxygen therapy in patients with AE-IP and RF.

Results

After one week of treatment, the ineffective rate of HFNC oxygen therapy in 136 patients with AE-IP and RF in the study was 16.91% (23/136). Compared with the effective group, the proportions of patients with respiratory tract infection and malnutrition were higher, the oxygenation index was lower, and the levels of arterial B-type natriuretic peptide (BNP) and procalcitonin (PCT) were significantly higher in the ineffective group (P＜0.05). There was no significant difference in other data between the two groups (P＞0.05). Logistic regression analysis showed that oxygenation index, BNP, PCT, respiratory tract infection, and malnutrition were related to the ineffectiveness of HFNC oxygen therapy in patients with AE-IP and RF. Low oxygenation index, high BNP, high PCT, respiratory tract infection, and malnutrition might be the risk factors for ineffectiveness of HFNC oxygen therapy in patients with AE-IP and RF (odds ratio＞1, P＜0.05). The forest plot showed that among the factors related to ineffectiveness of HFNC oxygen therapy in patients with AE-IP and RF, malnutrition had the strongest correlation.

Conclusion

There is a certain risk of ineffective HFNC oxygen therapy in patients with AE-IP and RF, and the ineffectiveness may be related to low oxygenation index, high BNP, high PCT, respiratory infection, and malnutrition.

Key words: Acute exacerbation of interstitial pneumonia, Respiratory failure, High flow nasal cannula oxygen therapy, Oxygenation index

Leilei Qu, Lijun Liu, Yinfang Liu. Factors related to ineffectiveness of high flow nasal cannula oxygen therapy in patients with acute exacerbation of interstitial pneumonia with respiratory failure[J]. Chinese Journal of Clinicians(Electronic Edition), 2022, 16(08): 769-774.

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Figures/Tables 3

因素	无效组（n=23）	有效组（n=113）	统计值	P值
性别［例（%）］			χ²=0.322	0.570
男性	13（56.52）	71（62.83）
女性	10（43.48）	42（37.17）
年龄（岁， $x ¯$ ±s）	64.43±7.34	63.61±6.16	t=0.565	0.573
吸烟史［例（%）］			χ²=0.094	0.759
是	12（52.17）	55（48.67）
否	11（47.83）	58（51.33）
IP病程（月， $x ¯$ ±s）	43.00±4.36	41.75±4.77	t=1.158	0.249
既往IP加重史［例（%）］			χ²=0.187^a	0.665^a
是	6（26.09）	22（19.47）
否	17（73.91）	91（80.53）
RF起病至就诊时间（h， $x ¯$ ±s）	9.65±1.15	9.37±1.07	t=1.131	0.260
入住ICU［例（%）］			χ²=0.204	0.652
是	14（60.87）	63（55.75）
否	9（39.13）	50（44.25）
APACHE Ⅱ评分（分， $x ¯$ ±s）	19.13±2.44	18.37±2.16	t=1.500	0.136
呼吸频率（次/min， $x ¯$ ±s）	30.13±3.67	28.90±3.22	t=1.626	0.106
心率（次/min， $x ¯$ ±s）	100.52±8.46	99.99±10.66	t=0.225	0.823
氧合指数（mmHg， $x ¯$ ±s）	187.71±17.51	199.22±18.46	t=2.749	0.007
PaCO₂（mmHg， $x ¯$ ±s）	35.04±3.11	34.54±3.69	t=0.605	0.546
BNP（ng/L， $x ¯$ ±s）	309.06±31.38	273.27±28.49	t=5.399	＜0.001
PCT（ng/L， $x ¯$ ±s）	523.45±50.54	458.58±43.24	t=6.369	＜0.001
WBC计数（×10⁹/L， $x ¯$ ±s）	7.28±0.87	7.52±0.93	t=1.163	0.247
呼吸道感染［例（%）］			χ²=6.730	0.009
是	10（43.48）	21（18.58）
否	13（56.52）	92（81.42）
营养不良［例（%）］			χ²=4.703^a	0.030^a
是	7（30.43）	12（10.62）
否	16（69.57）	101（89.38）

因素	无效组（n=23）	有效组（n=113）	统计值	P值
性别［例（%）］			χ²=0.322	0.570
男性	13（56.52）	71（62.83）
女性	10（43.48）	42（37.17）
年龄（岁， $x ¯$ ±s）	64.43±7.34	63.61±6.16	t=0.565	0.573
吸烟史［例（%）］			χ²=0.094	0.759
是	12（52.17）	55（48.67）
否	11（47.83）	58（51.33）
IP病程（月， $x ¯$ ±s）	43.00±4.36	41.75±4.77	t=1.158	0.249
既往IP加重史［例（%）］			χ²=0.187^a	0.665^a
是	6（26.09）	22（19.47）
否	17（73.91）	91（80.53）
RF起病至就诊时间（h， $x ¯$ ±s）	9.65±1.15	9.37±1.07	t=1.131	0.260
入住ICU［例（%）］			χ²=0.204	0.652
是	14（60.87）	63（55.75）
否	9（39.13）	50（44.25）
APACHE Ⅱ评分（分， $x ¯$ ±s）	19.13±2.44	18.37±2.16	t=1.500	0.136
呼吸频率（次/min， $x ¯$ ±s）	30.13±3.67	28.90±3.22	t=1.626	0.106
心率（次/min， $x ¯$ ±s）	100.52±8.46	99.99±10.66	t=0.225	0.823
氧合指数（mmHg， $x ¯$ ±s）	187.71±17.51	199.22±18.46	t=2.749	0.007
PaCO₂（mmHg， $x ¯$ ±s）	35.04±3.11	34.54±3.69	t=0.605	0.546
BNP（ng/L， $x ¯$ ±s）	309.06±31.38	273.27±28.49	t=5.399	＜0.001
PCT（ng/L， $x ¯$ ±s）	523.45±50.54	458.58±43.24	t=6.369	＜0.001
WBC计数（×10⁹/L， $x ¯$ ±s）	7.28±0.87	7.52±0.93	t=1.163	0.247
呼吸道感染［例（%）］			χ²=6.730	0.009
是	10（43.48）	21（18.58）
否	13（56.52）	92（81.42）
营养不良［例（%）］			χ²=4.703^a	0.030^a
是	7（30.43）	12（10.62）
否	16（69.57）	101（89.38）

因素	β值	SE	Wald	P值	OR值	95%CI
常量	-28.519	7.443	14.68	＜0.001	-	-
氧合指数	-0.034	0.013	6.863	0.009	0.966	0.942~0.991
BNP	0.041	0.009	18.981	＜0.001	1.042	1.023~1.061
PCT	0.033	0.007	20.978	＜0.001	1.033	1.019~1.048
呼吸道感染	1.215	0.485	6.27	0.012	3.37	1.302~8.722
营养不良	1.304	0.546	5.691	0.017	3.682	1.262~10.746

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