Objective To investigate the efficacy and safety of noninvasive ventilation (NIV) combined with high-flow nasal cannula oxygen therapy (HFNC) versus NIV as sequential post-extubation therapy in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Methods This retrospective cohort study enrolled AECOPD patients managed with invasive mechanical ventilation and sequential post-extubation therapy at West China Hospital of Sichuan University from January 2021 to September 2024. The patients were divided into a NIV group and a NIV-HFNC group based on sequential therapy modality. Outcomes included blood gas parameters (at 24h and 48h post-extubation), 7-day delirium incidence post-extubation, 7-day reintubation rate, 28-day mortality, NIV duration, intensive care unit (ICU) length of stay and hospital length of stay. Subgroup analyses were performed for the patients not reintubated within 48h post-extubation. Results A total of 156 patients were included, with 81 patients in the NIV group and 75 patients in the NIV-HFNC group. At 24h and 48h post-extubation, the NIV-HFNC group showed significantly lower PaCO2 (t=3.123, P=0.002; t=4.791, P<0.001) and HCO3– (t=2.313, P=0.022; t=4.605, P<0.001) levels, while pH (t=–2.287, P=0.024) at 48h was significantly higher than that in the NIV group. The 7-day reintubation rate (χ2=14.381, P<0.001) and the NIV duration (z=–3.495, P<0.001) were both significantly lower in the NIV-HFNC group than those in the NIV group. No significant differences were observed in 7-day delirium incidence, 28-day mortality, ICU or hospital length of stay (all P>0.05). Subgroup analyses showed that PaO2 at 48h post-extubation was significantly higher in the NIV-HFNC subgroup compared with the NIV subgroup (t=–2.390, P=0.018) while reintubation rate (χ2=4.693, P=0.030) and NIV duration (z=–4.936, P<0.001) were consistent with the overall results. Conclusion Compared with sequential NIV alone, NIV combined with HFNC as sequential therapy for AECOPD patients demonstrates superiority in improving post-extubation blood gas parameters, reducing reintubation rate and shortening NIV duration, offering a novel post-extubation respiratory support option to improve outcomes.
ObjectiveTo observe the relationship between ventilator-associated pneumonia (VAP) and changes in bronchial mucosa and sputum in critically ill patients. A prediction model for SEH score was developed according to the abnormal degrees of airway sputum , mucosal edema and mucosal hyperemia , as well as to analyze the diagnostic value of the SEH scores for VAP during bronchoscopy. MethodsA collection of general data and initial bronchoscopy results was conducted for patients admitted to the department of intensive care unit at West China Hospital from March 1, 2024, to July 1, 2024. Patients were divided into infection group (n=138) and non-infection group (n=227) according to diagnostic criteria for VAP based on the date of their first bronchoscopy. T-tests were used to compare baseline data between groups, while analysis of variance was employed to assess differences in airway mucosal and sputum lesions. A binary logistic regression model was constructed using the SEH scores for predicting VAP risk, with receiver operating characteristic curve area under the curve (AUC) utilized to evaluate model accuracy. ResultsA total of 365 patients were included in this study, among which 138 cases (37.8%) were diagnosed with VAP. The AUC for using SEH scores in diagnosing VAP was found to be 0.81 [95% confidence interval (CI) 0.76-0.85], with an optimal cutoff value set at 6.5. The sensitivity and specificity of SEH scores for diagnosing VAP were determined as 79.7% (95% CI: 72.2%-85.6%) and 73.1% (95% CI:67.0%-78.5%). Patients with SEH scores over 6.5 exhibited a significantly higher rate of VAP infection (64.3% vs.14.4%, P<0.0001), elevated white blood cell count levels (WBC) [(13.3±7.5 vs.1.8±6.2), P=0.04], as well as increased hospital mortality rates (39.8 % vs.24.2 %, P=0.002). ConclusionsThe SEH scores has a certain efficacy in the diagnosis of VAP in patients with mechanical ventilation. Compared with the traditional VAP diagnostic criteria, SEH scores is easier to obtain in clinical practice, and has certain clinical application value.