Study on the clinical efficacy of high-flow nasal cannula combined with prone position ventilation in patients with moderate-high risk community-acquired pneumonia based on CURB-65

Objective To explore the clinical efficacy of high-flow nasal cannula(HFNC) combined with prone position ventilation(PPV) in patients with moderate-high risk community-acquired pneumonia(CAP) based on URB-65.

Methods A total of 240 patients with moderate-high risk CAP requiring HFNC hospitalized in the Second People's Hospital of Fuyang City Anhui Province from March 2022 to March 2023 were enrolled, and randomly divided into the prone position group(122 cases) and control group(118 cases). The prone position group was treated with HFNC+PPV, while the control group was treated only with HFNC. The changes of pulse oxygen saturation(SpO₂) and respiratory rate(RR) were recorded in the prone position group before treatment(T₀), prone position for 60 min(T₁) and supine position for 30 min(T₂). The differences in the fraction of inhaled oxygen(FiO₂), PaO₂/FiO₂ and Borg score were compared between two groups on the third and fifth day of hospitalization. The length of hospital stay, medical expenses, tracheal intubation rate and related adverse reactions were compared between two groups.

Results Compared with T₀, the RR at T₁ and T₂ decreased, and the SpO₂ at T1 and T₂ increased in the prone position group(P < 0.05 to P < 0.01). The FiO₂ and Borg score in the prone position group were lower than those in control group, and the PaO₂/FiO₂ in the prone position group was higher than that in control group on the third and fifth day of treatment(P < 0.05 to P < 0.01). Compared with the control group, the length of hospital stay in the prone position group was shorter, the medical expenses and rate of tracheal intubation in the prone position group were lower(P < 0.05 to P < 0.01). The incidence of orbital edema, shoulder and back pain, and low back pain in the prone position group were higher than those in control group(P < 0.05).

Conclusions The HFNC combined with PPV can improve the PaO₂/FiO₂, reduce medical expenses, length of hospital stay and rate of intubation in moderate-high risk CAP pateints. Despite the high incidence of adverse reactions, patients can improve rapidly after active treatment.