Assistance Publique-Hôpitaux de Paris (APHP), Service de Réanimation Médicale, Hôpital Louis Mourier, F-92700, Colombes, France.
Respir Care. 2012 Nov;57(11):1873-8. doi: 10.4187/respcare.01575. Epub 2012 Mar 13.
Heated and humidified high flow nasal cannula oxygen therapy (HFNC) represents a new alternative to conventional oxygen therapy that has not been evaluated in the emergency department (ED). We aimed to study its feasibility and efficacy in patients exhibiting acute respiratory failure presenting to the ED.
Prospective, observational study in a university hospital's ED. Patients with acute respiratory failure requiring > 9 L/min oxygen or with ongoing clinical signs of respiratory distress despite oxygen therapy were included. The device of oxygen administration was then switched from non-rebreathing mask to HFNC. Dyspnea, rated by the Borg scale and a visual analog scale, respiratory rate, and S(pO(2)) were collected before and 15, 30, and 60 min after beginning HFNC. Feasibility was assessed through caregivers' acceptance of the device in terms of practicality and perceived effect on the subjects, evaluated by questionnaire.
Seventeen subjects, median age 64 y (46-84.7 y), were studied. Pneumonia was the most common reason for oxygen therapy (n = 9). HFNC was associated with a significant decrease in both dyspnea scores: Borg scale from 6 (5-7) to 3 (2-4) (P < .001), and visual analog scale from 7 (5-8) to 3 (1-5) (P < .01). Respiratory rate decreased from 28 breaths/min (25-32 breaths/min) to 25 breaths/min (21-28 breaths/min) (P < .001), and S(pO(2)) increased from 90% (88.5-94%) to 97% (92.5-100%) (P < .001). Fewer subjects exhibited clinical signs of respiratory distress (10/17 vs 3/17, P = .03). HFNC was well tolerated and no adverse event was noted. Altogether, 76% of healthcare givers declared preferring HFNC, as compared to conventional oxygen therapy.
HFNC is possible in the ED, and it alleviated dyspnea and improved respiratory parameters in subjects with acute hypoxemic respiratory failure.
加热和湿化高流量鼻导管氧疗（HFNC）代表了一种新的替代传统氧疗的方法，尚未在急诊科（ED）中进行评估。我们旨在研究其在 ED 中出现急性呼吸衰竭的患者中的可行性和疗效。
在一所大学医院的 ED 中进行前瞻性、观察性研究。纳入需要> 9 L/min 氧气或尽管接受氧疗仍有持续呼吸窘迫体征的急性呼吸衰竭患者。然后将给氧装置从无重复呼吸面罩切换为 HFNC。在开始 HFNC 前、后 15、30 和 60 分钟分别采集呼吸困难评分（Borg 量表和视觉模拟量表）、呼吸频率和 S(pO(2))。通过问卷调查评估护理人员对设备的实用性和对患者的感知效果，以评估可行性。
研究了 17 名患者，中位年龄 64 岁（46-84.7 岁）。肺炎是氧疗最常见的原因（n = 9）。HFNC 与呼吸困难评分的显著降低相关：Borg 量表从 6（5-7）降至 3（2-4）（P <.001），视觉模拟量表从 7（5-8）降至 3（1-5）（P <.01）。呼吸频率从 28 次/分钟（25-32 次/分钟）降至 25 次/分钟（21-28 次/分钟）（P <.001），S(pO(2))从 90%（88.5-94%）增加至 97%（92.5-100%）（P <.001）。呼吸窘迫的体征更少（10/17 与 3/17，P =.03）。HFNC 耐受良好，未观察到不良事件。总体而言，76%的医疗保健提供者表示更喜欢 HFNC，而不是传统氧疗。
HFNC 可在 ED 中实施，可缓解急性低氧性呼吸衰竭患者的呼吸困难并改善呼吸参数。
