Critical Care Department, Vall d'Hebron University Hospital, P. Vall d'Hebron 119-129. Annexe 5a planta-AG. E08035, Barcelona, Spain.
J Crit Care. 2012 Oct;27(5):434-9. doi: 10.1016/j.jcrc.2012.04.006. Epub 2012 Jul 2.
The experience with high-flow nasal cannula (HFNC) oxygen therapy in severe acute respiratory infection (SARI) is limited. The objective was to assess the effectiveness of HFNC oxygen therapy in adult patients with SARI by confirmed 2009 influenza A/H1N1v infection (by real-time reverse transcription polymerase chain reaction testing).
A single-center post hoc analysis of a cohort of intensive care unit patients admitted with SARI due to 2009 Influenza A/H1N1v was done. High-flow nasal cannula (Optiflow; Fisher & Paykel, Auckland, New Zealand) was indicated in the presence of acute respiratory failure when the patient was unable to maintain a pulse oxymetry more than 92% with more than 9 L/min of oxygen using a standard face mask conventional delivery systems. Nonresponders were defined by their need of subsequent mechanical ventilation.
Twenty-five nonintubated adult patients were admitted for SARI (21 pneumonia). Twenty were unable to maintain pulse oxymetry more than 92% with conventional oxygen administration and required HFNC O(2) therapy, which was successful in 9 (45%). All 8 patients on vasopressors required intubation within 24 hours. After 6 hours of HFNC O(2) therapy, nonresponders presented a lower Pao(2)/fraction of inspired oxygen (median, 135 [interquartile range, 84-210] vs 73 [56-81] mm Hg P < .05) and needed higher oxygen flow rate. No secondary infections were reported in health care workers. No nosocomial pneumonia occurred during HFNC O(2) therapy.
High-flow nasal cannula O(2) therapy appears to be an innovative and effective modality for early treatment of adults with SARI.
高流量鼻导管（HFNC）氧疗在严重急性呼吸道感染（SARI）中的应用经验有限。本研究旨在评估 HFNC 氧疗在经实时逆转录聚合酶链反应（RT-PCR）检测确诊的 2009 年甲型 H1N1v 流感感染所致成人 SARI 患者中的疗效。
对因 2009 年甲型 H1N1v 流感而入住重症监护病房的 SARI 患者进行了一项单中心回顾性队列分析。当患者使用标准面罩常规供氧系统无法维持脉搏血氧饱和度>92%且氧流量>9 L/min 时，即出现急性呼吸衰竭，提示使用 HFNC。无应答者定义为需要后续机械通气。
25 例未插管的成年 SARI 患者（21 例肺炎）纳入本研究。20 例患者常规氧疗后无法维持脉搏血氧饱和度>92%，需要 HFNC 氧疗，其中 9 例（45%）治疗成功。所有 8 例使用血管加压素的患者均在 24 小时内需要插管。HFNC 氧疗 6 小时后，无应答者的 PaO2/FiO2 比值较低（中位数，135 [四分位距，84-210]比 73 [56-81]mmHg，P<0.05），需要更高的氧流量。医护人员未报告发生继发性感染。HFNC 氧疗期间未发生医院获得性肺炎。
HFNC 氧疗似乎是治疗成人 SARI 的一种创新且有效的方法。
