低氧性呼吸衰竭患者的经鼻高流量氧疗：与传统氧疗和无创通气（NIV）相比，对功能和主观呼吸参数的影响
Nasal high-flow oxygen therapy in patients with hypoxic respiratory failure: effect on functional and subjective respiratory parameters compared to conventional oxygen therapy and non-invasive ventilation (NIV).
作者信息
Schwabbauer Norbert, Berg Björn, Blumenstock Gunnar, Haap Michael, Hetzel Jürgen, Riessen Reimer
机构信息
Department of Internal Medicine, Medical Intensive Care Unit, University of Tübingen, Otfried-Müller-Str, 10, Tübingen 72076, Germany.
Department of Clinical Epidemiology and Applied Biometry, University of Tübingen, Tübingen, Germany.
出版信息
BMC Anesthesiol. 2014 Aug 7;14:66. doi: 10.1186/1471-2253-14-66. eCollection 2014.
BACKGROUND
Aim of the study was to compare the short-term effects of oxygen therapy via a high-flow nasal cannula (HFNC) on functional and subjective respiratory parameters in patients with acute hypoxic respiratory failure in comparison to non-invasive ventilation (NIV) and standard treatment via a Venturi mask.
METHODS
Fourteen patients with acute hypoxic respiratory failure were treated with HFNC (FiO2 0.6, gas flow 55 l/min), NIV (FiO2 0.6, PEEP 5 cm H2O Hg, tidal volume 6-8 ml/kg ideal body weight,) and Venturi mask (FiO2 0.6, oxygen flow 15 l/min,) in a randomized order for 30 min each. Data collection included objective respiratory and circulatory parameters as well as a subjective rating of dyspnea and discomfort by the patients on a 10-point scale. In a final interview, all three methods were comparatively evaluated by each patient using a scale from 1 (=very good) to 6 (=failed) and the patients were asked to choose one method for further treatment.
RESULTS
PaO2 was highest under NIV (129 ± 38 mmHg) compared to HFNC (101 ± 34 mmHg, p <0.01 vs. NIV) and VM (85 ± 21 mmHg, p <0.001 vs. NIV, p <0.01 vs. HFNC, ANOVA). All other functional parameters showed no relevant differences. In contrast, dyspnea was significantly better using a HFNC (2.9 ± 2.1, 10-point Borg scale) compared to NIV (5.0 ± 3.3, p <0.05), whereas dyspnea rating under HFNC and VM (3.3 ± 2.3) was not significantly different. A similar pattern was found when patients rated their overall discomfort on the 10 point scale: HFNC 2.7 ± 1.8, VM 3.1 ± 2.8 (ns vs. HFNC), NIV 5.4 ± 3.1 (p <0.05 vs. HFNC). In the final evaluation patients gave the best ratings to HFNC 2.3 ± 1.4, followed by VM 3.2 ± 1.7 (ns vs. HFNC) and NIV 4.5 ± 1.7 (p <0.01 vs. HFNC and p <0.05 vs. VM). For further treatment 10 patients chose HFNC, three VM and one NIV.
CONCLUSIONS
In hypoxic respiratory failure HFNC offers a good balance between oxygenation and comfort compared to NIV and Venturi mask and seems to be well tolerated by patients.
TRIAL REGISTRATION
GERMAN CLINICAL TRIALS REGISTER: DRKS00005132.
背景
本研究的目的是比较高流量鼻导管（HFNC）氧疗与无创通气（NIV）和文丘里面罩标准治疗相比，对急性低氧性呼吸衰竭患者功能和主观呼吸参数的短期影响。
方法
14例急性低氧性呼吸衰竭患者，分别接受HFNC（FiO2 0.6，气流55升/分钟）、NIV（FiO2 0.6，PEEP 5厘米水柱，潮气量6 - 8毫升/千克理想体重）和文丘里面罩（FiO2 0.6，氧流量15升/分钟）治疗，每种治疗方式随机进行30分钟。数据收集包括客观呼吸和循环参数，以及患者对呼吸困难和不适程度的主观10分制评分。在最后一次访谈中，每位患者使用1（=非常好）至6（=失败）的量表对三种方法进行比较评估，并要求患者选择一种方法进行进一步治疗。
结果
与HFNC（101±34 mmHg，与NIV相比p<0.01）和文丘里面罩（85±21 mmHg，与NIV相比p<0.001，与HFNC相比p<0.01，方差分析）相比，NIV治疗下的PaO2最高（129±38 mmHg）。所有其他功能参数均无显著差异。相比之下，与NIV（5.0±3.3，p<0.05）相比，使用HFNC时呼吸困难明显改善（2.9±2.1，10分制Borg量表），而HFNC和文丘里面罩下的呼吸困难评分（3.3±2.3）无显著差异。当患者在10分制量表上对整体不适进行评分时也发现了类似模式：HFNC为2.7±1.8，文丘里面罩为3.1±2.8（与HFNC相比无显著差异），NIV为5.4±3.1（与HFNC相比p<0.05）。在最终评估中，患者对HFNC的评分最高，为2.3±1.4，其次是文丘里面罩3.2±1.7（与HFNC相比无显著差异）和NIV 4.5±1.7（与HFNC相比p<0.01，与文丘里面罩相比p<0.05）。对于进一步治疗，10例患者选择HFNC，3例选择文丘里面罩，1例选择NIV。
结论
在低氧性呼吸衰竭中，与NIV和文丘里面罩相比，HFNC在氧合和舒适度之间提供了良好的平衡，并且似乎患者耐受性良好。
试验注册
德国临床试验注册中心：DRKS00005132
Zotero 插件