Jones Peter G, Kamona Sinan, Doran Owen, Sawtell Frann, Wilsher Margaret
Department of Adult Emergency Medicine
Department of Adult Emergency Medicine.
Respir Care. 2016 Mar;61(3):291-9. doi: 10.4187/respcare.04252. Epub 2015 Nov 17.
Humidified high-flow nasal cannula (HFNC) is a novel method of oxygen delivery with increasing use in emergency departments and intensive care settings despite little evidence showing benefit over standard oxygen delivery methods (standard O2). The aim of this study was to determine whether HFNC compared with standard O2 given to subjects in acute respiratory distress would reduce the need for noninvasive ventilation or invasive ventilation.
This was a pragmatic open randomized controlled trial in adult subjects with hypoxia and tachypnea presenting to a tertiary academic hospital emergency department. The primary outcome was the need for mechanical ventilation in the emergency department.
We screened 1,287 patients, 322 met entry criteria and 19 were excluded from analysis. Of these, 165 randomized to HFNC and 138 to standard O2 were analyzed. Baseline characteristics were similar. In the HFNC group, 3.6% (95% CI 1.5-7.9%) versus 7.2% (95% CI 3.8-13%) in the standard O2 group required mechanical ventilation in the emergency department (P = .16), and 5.5% (95% CI 2.8-10.2%) in HFNC versus 11.6% (95% CI 7.2-18.1%) in the standard O2 group required mechanical ventilation within 24 h of admission (P = .053). There was no difference in mortality or stay. Adverse effects were infrequent; however, fewer subjects in the HFNC group had a fall in Glasgow coma score due to CO2 retention, 0% (95% CI 0-3%) versus 2.2% (95% CI 0.4-6%). One in 12 subjects did not tolerate HFNC.
HFNC was not shown to reduce the need for mechanical ventilation in the emergency department for subjects with acute respiratory distress compared with standard O2, although it was safe and may reduce the need for escalation of oxygen therapy within the first 24 h of admission.
高流量鼻导管湿化吸氧（HFNC）是一种新型的氧输送方法，尽管几乎没有证据表明其优于标准氧输送方法（标准O₂），但在急诊科和重症监护环境中的使用却日益增加。本研究的目的是确定与给予急性呼吸窘迫患者的标准O₂相比，HFNC是否会减少无创通气或有创通气的需求。
这是一项针对三级学术医院急诊科中出现缺氧和呼吸急促的成年患者的实用开放性随机对照试验。主要结局是急诊科中机械通气的需求。
我们筛查了1287例患者，322例符合纳入标准，19例被排除在分析之外。其中，对随机分配至HFNC组的165例患者和随机分配至标准O₂组的138例患者进行了分析。基线特征相似。在急诊科中，HFNC组需要机械通气的患者比例为3.6%（95%CI 1.5-7.9%），而标准O₂组为7.2%（95%CI 3.8-13%）（P = 0.16）；入院后24小时内，HFNC组需要机械通气的患者比例为5.5%（95%CI 2.8-10.2%），标准O₂组为11.6%（95%CI 7.2-18.1%）（P = 0.053）。死亡率或住院时间无差异。不良反应很少见；然而，HFNC组中因二氧化碳潴留导致格拉斯哥昏迷评分下降的患者较少，为0%（95%CI 0-3%），而标准O₂组为2.2%（95%CI 0.4-6%）。12名受试者中有1名不耐受HFNC。
与标准O₂相比，未显示HFNC可减少急性呼吸窘迫患者在急诊科的机械通气需求，尽管它是安全的，且可能减少入院后24小时内升级氧疗的需求。
