Nishimura Masaji
Department of Emergency and Critical Care Medicine, Tokushima University Graduate School, Kuramoto, Tokushima, Japan.
Respir Care. 2016 Apr;61(4):529-41. doi: 10.4187/respcare.04577.
High-flow nasal cannula (HFNC) oxygen therapy is carried out using an air/oxygen blender, active humidifier, single heated tube, and nasal cannula. Able to deliver adequately heated and humidified medical gas at flows up to 60 L/min, it is considered to have a number of physiological advantages compared with other standard oxygen therapies, including reduced anatomical dead space, PEEP, constant F(IO2), and good humidification. Although few large randomized clinical trials have been performed, HFNC has been gaining attention as an alternative respiratory support for critically ill patients. Published data are mostly available for neonates. For critically ill adults, however, evidence is uneven because the reports cover various subjects with diverse underlying conditions, such as hypoxemic respiratory failure, exacerbation of COPD, postextubation, preintubation oxygenation, sleep apnea, acute heart failure, and conditions entailing do-not-intubate orders. Even so, across the diversity, many published reports suggest that HFNC decreases breathing frequency and work of breathing and reduces the need for respiratory support escalation. Some important issues remain to be resolved, such as definitive indications for HFNC and criteria for timing the starting and stopping of HFNC and for escalating treatment. Despite these issues, HFNC has emerged as an innovative and effective modality for early treatment of adults with respiratory failure with diverse underlying diseases.
高流量鼻导管（HFNC）氧疗通过空气/氧气混合器、主动加湿器、单根加热管和鼻导管来实施。它能够以高达60L/分钟的流量输送充分加热和加湿的医用气体，与其他标准氧疗相比，被认为具有一些生理优势，包括减少解剖死腔、呼气末正压、恒定的吸入氧浓度（F(IO2)）以及良好的湿化效果。尽管很少有大型随机临床试验，但HFNC作为重症患者的一种替代性呼吸支持方式正受到关注。已发表的数据大多来自新生儿。然而，对于重症成人患者，证据并不一致，因为报告涵盖了各种不同基础疾病的受试者，如低氧性呼吸衰竭、慢性阻塞性肺疾病（COPD）急性加重、拔管后、插管前氧合、睡眠呼吸暂停、急性心力衰竭以及下达不插管医嘱的情况。即便如此，在这些不同情况中，许多已发表的报告表明HFNC可降低呼吸频率和呼吸功，并减少呼吸支持升级的需求。一些重要问题仍有待解决，例如HFNC的确切适应证以及启动和停止HFNC以及升级治疗的时机标准。尽管存在这些问题，HFNC已成为早期治疗患有各种基础疾病的呼吸衰竭成人患者的一种创新且有效的方式。
