Réanimation des Détresses Respiratoires et Infections Sévères, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Chemin des Bourrely, 13015, Marseille, France.
URMITE UMR CNRS 7278, Faculté de Médecine, Aix-Marseille Université, 13005, Marseille, France.
Intensive Care Med. 2016 Sep;42(9):1336-49. doi: 10.1007/s00134-016-4277-8. Epub 2016 Mar 11.
Oxygen therapy can be delivered using low-flow, intermediate-flow (air entrainment mask), or high-flow devices. Low/intermediate-flow oxygen devices have several drawbacks that cause critically ill patients discomfort and translate into suboptimal clinical results. These include limitation of the FiO2 (due to the high inspiratory flow often observed in patients with respiratory failure), and insufficient humidification and warming of the inspired gas. High-flow nasal cannula oxygenation (HFNCO) delivers oxygen flow rates of up to 60 L/min and over the last decade its effect on clinical outcomes has widely been evaluated, such as in the improvement of respiratory distress, the need for intubation, and mortality. Mechanisms of action of HFNCO are complex and not limited to the increased oxygen flow rate. The main aim of this review is to guide clinicians towards evidence-based clinical practice guidelines. It summarizes current knowledge about HFNCO use in ICU patients and the potential areas of uncertainties. For instance, it has been recently suggested that HFNCO could improve the outcome of patients with hypoxemic acute respiratory failure. In other settings, research is ongoing and additional evidence is needed. For instance, if intubation is required, studies suggest that HFNCO may help to improve preoxygenation and can be used after extubation. Likewise, HFNCO might be used in obese patients, or to prevent respiratory deterioration in hypoxemic patients requiring bronchoscopy, or for the delivery of aerosol therapy. However, areas for which conclusive data exist are limited and interventions using standardized HFNCO protocols, comparators, and relevant clinical outcomes are warranted.
氧疗可以通过低流量、中流量（空气夹带面罩）或高流量设备进行。低/中流量氧气设备存在一些缺点，会导致重症患者感到不适，并导致临床效果不佳。这些缺点包括 FiO2 受限（由于呼吸衰竭患者经常观察到高吸气流量），以及吸入气体的加湿和加热不足。高流量鼻导管氧疗（HFNCO）可提供高达 60 L/min 的氧气流速，在过去十年中，其对临床结果的影响已得到广泛评估，例如改善呼吸困难、需要插管和死亡率。HFNCO 的作用机制复杂，不仅限于增加氧气流速。本综述的主要目的是为临床医生提供循证临床实践指南。它总结了目前关于 ICU 患者使用 HFNCO 的知识以及潜在的不确定领域。例如，最近有人提出 HFNCO 可以改善低氧性急性呼吸衰竭患者的预后。在其他情况下，研究正在进行，需要更多的证据。例如，如果需要插管，研究表明 HFNCO 可以帮助改善预充氧，并可在拔管后使用。同样，HFNCO 可用于肥胖患者，或在需要支气管镜检查的低氧血症患者中预防呼吸恶化，或用于输送气溶胶治疗。然而，存在明确数据的领域有限，需要使用标准化的 HFNCO 方案、对照和相关临床结果进行干预。
