Discipline of Nursing, The University of Adelaide, Adelaide, SA 5005, Australia.
Aust Crit Care. 2010 May;23(2):53-70. doi: 10.1016/j.aucc.2010.01.001. Epub 2010 Mar 5.
Humidified high flow nasal cannula oxygen therapy is increasingly available in Australian adult intensive care units. Its use in paediatric populations has been extensively studied and has shown positive effects however its clinical effectiveness in adults has not been established.
A systematic review of the literature was conducted to critique current evidence, inform nursing practice and make recommendations for nursing research.
An extensive search strategy identified clinical studies comparing standard oxygen therapy with high flow therapy in critical care units. Two reviewers independently assessed articles for eligibility, methodological quality and inclusion. Outcomes of interest included oxygenation, ventilation, work of breathing, positive airway pressure, patient comfort and long term effect. A narrative synthesis was conducted to describe the emerging evidence.
Eight studies were included for review. All were abstracts or poster presentations from scientific meetings therefore the quality of data available for analysis was poor. Findings indicated there was preliminary evidence to support the use of high flow therapy to optimise oxygenation in adults. This therapy may reduce the effort of breathing and provide augmented airway pressures. Patients described the therapy as comfortable. No definitive evidence supported the claim that ventilation is improved or conclusively demonstrated a long-term effect.
Humidified high flow nasal cannula may be used as an intermediate therapy to improve oxygenation in adult critical care patients. Further research is required to determine the duration of effect of the therapy, identify the patient population for whom it is most beneficial and evaluate long-term outcomes; to enable definitive recommendations for practice to be made.
湿化高流量鼻导管氧疗在澳大利亚成人重症监护病房中越来越普及。其在儿科人群中的应用已得到广泛研究，并显示出积极的效果，但在成人中的临床效果尚未确定。
对文献进行系统评价，以评价现有证据，为护理实践提供信息，并为护理研究提出建议。
采用广泛的搜索策略，确定了比较重症监护病房中标准氧疗与高流量治疗的临床研究。两名评审员独立评估文章的合格性、方法学质量和纳入情况。感兴趣的结果包括氧合、通气、呼吸功、正压通气、患者舒适度和长期效果。进行了叙述性综合，以描述新出现的证据。
共纳入 8 项研究进行综述。所有研究均为科学会议的摘要或海报展示，因此可用于分析的数据质量较差。研究结果表明，有初步证据支持使用高流量治疗来优化成人的氧合。这种治疗方法可能会减轻呼吸的努力，并提供增强的气道压力。患者描述这种治疗方法很舒适。没有明确的证据支持通气得到改善的说法，也没有明确证明长期效果。
湿化高流量鼻导管可作为改善成人重症监护患者氧合的一种中间治疗方法。需要进一步研究以确定治疗效果的持续时间，确定最受益的患者人群，并评估长期结果，以便为实践提供明确的建议。
