Prone position ventilation combined with high-flow nasal cannula oxygen therapy in patients with pulmonary infection:...

Pulmonary infections are a common and serious clinical condition, particularly affecting critically ill patients, and effective respiratory management is crucial for recovery. This study examined the clinical and nursing outcomes associated with prone position ventilation (PPV) combined with high-flow nasal cannula (HFNC) oxygen therapy in patients with pulmonary infection.

We conducted a retrospective analysis of 200 patients with pulmonary infection admitted to two tertiary hospitals between January 2022 and January 2024. On the basis of the respiratory support actually received during hospitalization (non-randomized allocation), patients were assigned to an observation group (n = 100; PPV combined with HFNC) or a control group (n = 100; conventional oxygen therapy); the two groups were frequency-matched for age and baseline disease severity. Outcomes included the oxygenation index (PaO2/FiO2 ratio, SpO2), respiratory rate (RR), length of hospital stay, complication and ICU-admission rates, and nurse-assessed comfort and compliance. Longitudinal oxygenation data were analysed with repeated-measures analysis of variance (ANOVA) and Bonferroni-corrected post-hoc comparisons, and prespecified multivariable-adjusted and sensitivity analyses were performed.

Over the first 72 h, the observation group showed greater improvements in PaO₂/FiO₂ ratio and SpO₂ and a greater reduction in RR than the control group; the adjusted between-group difference in PaO₂/FiO₂ ratio at 72 h was 48.6 mmHg (95% CI, 41.5 to 55.7). Nurse-assessed comfort and compliance scores were higher in the observation group, and total complications (9.0% vs. 45.0%), ICU admission (5.0% vs. 19.0%) and length of stay (8.7 ± 2.4 vs. 12.0 ± 2.9 days) were lower; 30-day readmission did not differ. Results were consistent in multivariable-adjusted, propensity-score-adjusted, ICU-excluded and temporal sensitivity analyses.

In this retrospective, non-randomized cohort, PPV combined with HFNC oxygen therapy was associated with better respiratory outcomes, fewer complications, shorter hospitalization and higher nurse-assessed comfort and compliance than conventional oxygen therapy. Because treatment allocation was not randomized, these associations cannot establish causality, and prospective randomized trials are needed to confirm the findings in larger cohorts.