Brotfain Evgeni, Zlotnik Alexander, Schwartz Andrei, Frenkel Amit, Koyfman Leonid, Gruenbaum Shaun E, Klein Moti
Department of Anesthesiology and Critical Care, Soroka Medical Center, Ben-Gurion University of Negev, Beer Sheva, Israel.
Isr Med Assoc J. 2014 Nov;16(11):718-22.
Optimal oxygen supply is the cornerstone of the management of critically ill patients after extubation, especially in patients at high risk for extubation failure. In recent years, high flow oxygen system devices have offered an appropriate alternative to standard oxygen therapy devices such as conventional face masks and nasal prongs.
To assess the clinical effects of high flow nasal cannula (HFNC) compared with standard oxygen face masks in Intensive Care Unit (ICU) patients after extubation.
We retrospectively analyzed 67 consecutive ventilated critical care patients in the ICU over a period of 1 year. The patients were allocated to two treatment groups: HFNC (34 patients, group 1) and non-rebreathing oxygen face mask (NRB) (33 patients, group 2). Vital respiratory and hemodynamic parameters were assessed prior to extubation and 6 hours after extubation. The primary clinical outcomes measured were improvement in oxygenation, ventilation-free days, re-intubation, ICU length of stay, and mortality.
The two groups demonstrated similar hemodynamic patterns before and after extubation. The respiratory rate was slightly elevated in both groups after extubation with no differences observed between groups. There were no statistically significant clinical differences in PaCO2. However, the use of HFNC resulted in improved PaO2/FiO2 post-extubation (P < 0.05). There were more ventilator-free days in the HFNC group (P< 0.05) and fewer patients required reintubation (1 vs. 6). There were no differences in ICU length of stay or mortality.
This study demonstrated better oxygenation for patients treated with HFNC compared with NRB after extubation. HFNC may be more effective than standard oxygen supply devices for oxygenation in the post-extubation period.
最佳氧供是拔管后危重症患者管理的基石，尤其是对于拔管失败风险较高的患者。近年来，高流量氧疗系统设备为传统面罩和鼻导管等标准氧疗设备提供了合适的替代方案。
评估高流量鼻导管（HFNC）与标准氧面罩相比，对重症监护病房（ICU）拔管后患者的临床效果。
我们回顾性分析了1年内ICU中连续67例接受机械通气的危重症患者。患者被分为两个治疗组：HFNC组（34例患者，第1组）和非重复呼吸氧面罩（NRB）组（33例患者，第2组）。在拔管前和拔管后6小时评估重要的呼吸和血流动力学参数。主要测量的临床结局包括氧合改善、无通气天数、再次插管、ICU住院时间和死亡率。
两组在拔管前后的血流动力学模式相似。两组拔管后呼吸频率均略有升高，组间无差异。PaCO2在临床上无统计学显著差异。然而，使用HFNC可使拔管后PaO2/FiO2改善（P<0.05）。HFNC组的无通气天数更多（P<0.05），需要再次插管的患者更少（1例 vs. 6例）。ICU住院时间和死亡率无差异。
本研究表明，与NRB相比，HFNC治疗的患者在拔管后氧合更好。在拔管后时期，HFNC在氧合方面可能比标准氧供设备更有效。
