Universität Witten-Herdecke, Ambrocker Weg 60, 58091, Hagen, Germany.
Adv Exp Med Biol. 2013;755:27-34. doi: 10.1007/978-94-007-4546-9_4.
High flow nasal insufflations (NI) can improve gas exchange and alleviate dyspnea in patients with acute respiratory failure. In the present study we investigated the effects of high flow nasal insufflations in COPD patients with chronic hypercapnic respiratory failure (HRF). Seventeen patients with severe COPD and HRF were recruited. We delivered a mixture of 20 L/min room air and 2 L/min O(2) through a nasal cannula either into both nostrils (NI) or into one nostril (Partial NI). Respiratory pattern and PaCO(2) responses under NI were compared with low flow oxygen of 2 L/min. High flow nasal insufflations led to a systematic reduction in respiratory rate from 19.8 ± 4.2 at baseline to 18.0 ± 4.7 during NI (p < 0.008) and 18.1 ± 5.2 breaths/min during Partial NI (P < 0.03). The mean group inspiratory duty cycle (T(I)/T(T)) and mean group PaCO(2) remained constant between all experimental conditions. Individual responses to NI were heterogeneous: six patients demonstrated marked reductions in respiratory rate (>20% fall from baseline), another group (n = 6) demonstrated no change in respiratory rate but marked reductions in arterial carbon dioxide of more than 8 mmHg. In conclusion, high flow (20 L/min) nasal insufflations of warm and humidified air during wakefulness for 45 min reduced respiratory rate without deterioration of hypercapnia. Our data indicate that high flow NI improved efficiency of breathing and may be used as an adjunct to low flow oxygen for preventing hypercapnic respiratory failure in severely ill COPD patients.
高流量鼻内通气（NI）可以改善急性呼吸衰竭患者的气体交换并缓解呼吸困难。在本研究中，我们研究了高流量鼻内通气对慢性高碳酸血症性呼吸衰竭（HRF）的 COPD 患者的影响。招募了 17 名患有严重 COPD 和 HRF 的患者。我们通过鼻导管将 20 L/min 的室内空气和 2 L/min 的 O(2)混合物输送到两个鼻孔（NI）或一个鼻孔（部分 NI）。将 NI 下的呼吸模式和 PaCO(2)反应与 2 L/min 的低流量氧气进行比较。高流量鼻内通气导致呼吸频率从基线时的 19.8±4.2 次/min 系统性降低到 NI 时的 18.0±4.7 次/min（p<0.008）和部分 NI 时的 18.1±5.2 次/min（P<0.03）。平均组吸气时间/总时间（T(I)/T(T)）和平均组 PaCO(2)在所有实验条件下保持不变。NI 的个体反应存在异质性：6 名患者的呼吸频率明显降低（比基线下降超过 20%），另一组（n=6）的呼吸频率没有变化，但动脉二氧化碳分压降低超过 8 mmHg。总之，在清醒状态下用 20 L/min 的高流量（20 L/min）加热和加湿空气进行 45 分钟的鼻内通气可降低呼吸频率，而不会导致高碳酸血症恶化。我们的数据表明，高流量 NI 提高了呼吸效率，可作为低流量氧气的辅助手段，用于预防重症 COPD 患者的高碳酸血症性呼吸衰竭。
