Effect of High-Flow Nasal Cannula Oxygen Therapy with Awake Prone Position Ventilation vs. Supine Position Ventilation in Patients with Severe Pneumonia: A Quasi-Experimental Study

Objective: This study aims to evaluate the effect of high-flow nasal cannula (HFNC) oxygen therapy combined with awake prone position ventilation (APPV) vs. supine position ventilation (SPV) in patients with severe pneumonia. Methods: This is a quasi-experimental study enrolled patients diagnosed with severe pneumonia from the Department of Respiratory and Critical Care Medicine of the Fourth People's Hospital of Zigong City between November 2021 and January 2023. The primary endpoint was the treatment effectiveness, and the secondary endpoints included 72 h respiratory rate oxygenation index, oxygenation index, procalcitonin within 72 h, C-reactive protein within 72 h and partial pressure of oxygen within 24 h, blood lactate within 24 h, total length of hospital stay, endotracheal intubation rate within 2 weeks, readmission rate within 6 weeks, mortality rate within 4 weeks and incidence of adverse events. Results: A total of 120 patients with severe pneumonia were enrolled, evenly divided with 60 patients receiving HFNC+APPV and the other 60 receiving HFNC+SPV. The HFNC+APPV group demonstrated higher efficacy (90.0% vs. 76.7%, P=0.040) and shorter length of hospital stay (11.00(9.00,13.00) vs. 12.00(10.00,16.00), P=0.004) compared to the HFNC+SPV group. There was no significant difference in ROX index, CRP, PCT, lactate, PO2 and the onset of days, times of transferred to ICU within 1 week, times of transferred to ICU within 2 weeks, endotracheal intubation rate within 2 weeks, readmission rate within 6 weeks and mortality rate within 4 weeks between the HFNC+APPV group and HFNC+SPV group (P>0.05). The generalized estimation equation showed that the OI index at 12h, 24h, 48h and 72h was significantly higher than that at 0h (P<0.001), however, there was no significant difference in the change between HFNC+APPV group and HFNC+SPV group (P=0.604). There was no significant difference in the rate of adverse events between the HFNC+APPV group and HFNC+SPV group (P>0.05). Conclusion: The findings suggest that combining HFNC with APPV can enhance treatment efficacy and reduce hospitalization duration in severe pneumonia patients, offering valuable guidance for ventilation treatment positioning.