Objective:To investigate the risk factors of high flow nasal cannula oxygen therapy (HFNC) failure on severe acute pancreatitis (SAP) patients complicated with acute respiratory distress syndrome (ARDS) in order to improve the initial respiratory supporting effect. Methods:The data of SAP patients complicated with ARDS who were admitted to intensive care unit and treated with HFNC therapy in Affiliated Hospital of Nantong University from January 2016 to December 2017 were retrospectively analyzed. The patients were divided into failure group and success group according to whether need mechanical ventilation (including invasive ventilation or non-invasive ventilation) after HFNC. The clinical characteristics were reviewed and compared between the two groups which included baseline characteristics, the onset of disease, intra-abdominal pressure, APACHE Ⅱ, SOFA score, 24 h fluid intake, serum calcium, total bilirubin, serum amylase, procalcitonin, modified CT severity index, Murray's acute lung injury score, parameter of HFNC, breathing signs and blood-gas analysis after 1 hour treatment, whether abdominal drainage and blood purification was applied in 24 h. Results:Total of 84 patients were enrolled in this study, HFNC failure group had 36 patients and HFNC success group had 48 patients. No differences were found between the groups in age, sex, BMI, onset time, initial parameter of HFNC. Univariate analyses showed that intra-abdominal pressure (P=0.034), APACHEⅡscore (P=0.026), SOFA score (P=0.043) in the failure group were higher than those in the success group and 24 h liquid input (P=0.037) in the failure group was more than that in the success group. Multivariate analysis indicated that intra-abdominal pressure (OR=1.618, 95% CI 1.070~2.446, P=0.023), APACHEⅡ score (OR=1.950, 95% CI 1.269~2.996, P=0.012), SOFA score (OR=1.748, 95% CI 1.156~2.296, P=0.032) and 24 h fluid input (OR=1.852, 95% CI 1.349~2.896, P=0.023) were independent risk factors of HFNC failure. Conclusions:SAP patients complicated with ARDS should be closely monitored on intra-abdominal pressure, dynamic assessment of APACHEⅡ score and SOFA score and avoid excessive fluid input in 24 h. Mechanical ventilation should be given in time when HFNC fails.
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