高流量氧疗在急性呼吸衰竭中的应用。

High-flow oxygen therapy in acute respiratory failure.

机构信息

Servei de Medicina Intensiva (Area General), Hospital Universitari Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain.

出版信息

Respir Care. 2010 Apr;55(4):408-13.

PMID:20406507

Abstract

OBJECTIVE

To compare the comfort of oxygen therapy via high-flow nasal cannula (HFNC) versus via conventional face mask in patients with acute respiratory failure. Acute respiratory failure was defined as blood oxygen saturation < 96% while receiving a fraction of inspired oxygen > or = 0.50 via face mask.

METHODS

Oxygen was first humidified with a bubble humidifier and delivered via face mask for 30 min, and then via HFNC with heated humidifier for another 30 min. At the end of each 30-min period we asked the patient to evaluate dyspnea, mouth dryness, and overall comfort, on a visual analog scale of 0 (lowest) to 10 (highest). The results are expressed as median and interquartile range values.

RESULTS

We included 20 patients, with a median age of 57 (40-70) years. The total gas flow administered was higher with the HFNC than with the face mask (30 [21.3-38.7] L/min vs 15 [12-20] L/min, P < .001). The HFNC was associated with less dyspnea (3.8 [1.3-5.8] vs 6.8 [4.1-7.9], P = .001) and mouth dryness (5 [2.3-7] vs 9.5 [8-10], P < .001), and was more comfortable (9 [8-10]) versus 5 [2.3-6.8], P < .001). HFNC was associated with higher P(aO(2)) (127 [83-191] mm Hg vs 77 [64-88] mm Hg, P = .002) and lower respiratory rate (21 [18-27] breaths/min vs 28 [25-32] breaths/min, P < .001), but no difference in P(aCO(2)).

CONCLUSIONS

HFNC was better tolerated and more comfortable than face mask. HFNC was associated with better oxygenation and lower respiratory rate. HFNC could have an important role in the treatment of patients with acute respiratory failure.

摘要

目的

比较急性呼吸衰竭患者经高流量鼻导管（HFNC）和常规面罩吸氧的舒适度。急性呼吸衰竭定义为：患者在接受面罩吸氧时，氧分数（FiO2）≥0.50，但血氧饱和度（SpO2）<96%。

方法

首先用气泡式湿化器对氧气进行湿化，通过面罩给患者吸氧 30 分钟，然后再通过带有热湿交换器的 HFNC 给患者吸氧 30 分钟。在每个 30 分钟结束时，我们使用视觉模拟评分（0 分代表最低，10 分代表最高）让患者评价呼吸困难、口干和整体舒适度。结果以中位数和四分位距表示。

结果

我们纳入了 20 名患者，年龄中位数为 57（40-70）岁。HFNC 的总气体流量高于面罩（30[21.3-38.7]L/min 比 15[12-20]L/min，P<.001）。HFNC 与较低的呼吸困难（3.8[1.3-5.8]比 6.8[4.1-7.9]，P=.001）和口干（5[2.3-7]比 9.5[8-10]，P<.001）相关，并且更舒适（9[8-10]比 5[2.3-6.8]，P<.001）。HFNC 与较高的动脉血氧分压（PaO2）（127[83-191]mmHg 比 77[64-88]mmHg，P=.002）和较低的呼吸频率（21[18-27]次/分比 28[25-32]次/分，P<.001）相关，但动脉血二氧化碳分压（PaCO2）无差异。