Biselli Paolo J C, Kirkness Jason P, Grote Ludger, Fricke Kathrin, Schwartz Alan R, Smith Philip, Schneider Hartmut
Johns Hopkins Sleep Disorder Center, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland;
Intensive Care Unit, Division of Internal Medicine, University Hospital, University of São Paulo, São Paulo, Brazil; and.
J Appl Physiol (1985). 2017 Jan 1;122(1):82-88. doi: 10.1152/japplphysiol.00279.2016. Epub 2016 Nov 4.
Patients with chronic obstructive pulmonary disease (COPD) endure excessive resistive and elastic loads leading to chronic respiratory failure. Oxygen supplementation corrects hypoxemia but is not expected to reduce mechanical loads. Nasal high-flow (NHF) therapy supports breathing by reducing dead space, but it is unclear how it affects mechanical loads of patients with COPD. The objective of this study was to compare the effects of low-flow oxygen and NHF therapy on ventilation and work of breathing (WOB) in patients with COPD and controls during sleep. Patients with COPD (n = 12) and controls (n = 6) were recruited and submitted to polysomnography to measure sleep parameters and ventilation in response to administration of oxygen and NHF. A subset of six patients also had an esophageal catheter inserted for the purpose of measuring WOB. Patients with COPD had similar minute ventilation (V̇e) but lower tidal volumes than matched controls. With oxygen, [Formula: see text]was increased and V̇e was reduced in both controls and patients with COPD, but there was an increase in transcutaneous CO levels. NHF produced a greater reduction in V̇e and was associated with a reduction in CO levels. Although NHF halved WOB, oxygen produced only a minor reduction in this parameter. We conclude that oxygen produced little change in WOB, which was associated with CO elevations. On the other hand, NHF produced a large reduction in V̇e and WOB with a concomitant decrease in CO levels. Our data indicate that NHF improves alveolar ventilation during sleep compared with oxygen and room air in patients with COPD and therefore can decrease their cost of breathing.
NEW & NOTEWORTHY: Nasal high-flow (NHF) therapy can support ventilation in patients with chronic obstructive pulmonary disease during sleep by decreasing the work of breathing and improving CO levels. On the other hand, oxygen supplementation corrects hypoxemia, but it produces only a minimal reduction in work of breathing and is associated with increased CO levels. Therefore, NHF can be a useful method to assist ventilation in patients with increased respiratory mechanical loads.
慢性阻塞性肺疾病（COPD）患者承受着过度的阻力和弹性负荷，导致慢性呼吸衰竭。补充氧气可纠正低氧血症，但预计不会降低机械负荷。经鼻高流量（NHF）治疗通过减少死腔来支持呼吸，但尚不清楚其对COPD患者机械负荷的影响。本研究的目的是比较低流量氧气和NHF治疗对COPD患者和对照组睡眠期间通气和呼吸功（WOB）的影响。招募了COPD患者（n = 12）和对照组（n = 6），并进行多导睡眠图检查，以测量睡眠参数以及对氧气和NHF给药的通气反应。六名患者的一个亚组还插入了食管导管以测量WOB。COPD患者的分钟通气量（V̇e）相似，但潮气量低于匹配的对照组。使用氧气时，对照组和COPD患者的[公式：见正文]均增加，V̇e降低，但经皮CO水平升高。NHF使V̇e降低幅度更大，并且与CO水平降低相关。尽管NHF使WOB减半，但氧气仅使该参数略有降低。我们得出结论，氧气使WOB变化很小，这与CO升高有关。另一方面，NHF使V̇e和WOB大幅降低，同时CO水平降低。我们的数据表明，与氧气和室内空气相比，NHF可改善COPD患者睡眠期间的肺泡通气，因此可以降低其呼吸成本。
经鼻高流量（NHF）治疗可通过降低呼吸功和改善CO水平来支持慢性阻塞性肺疾病患者睡眠期间的通气。另一方面，补充氧气可纠正低氧血症，但仅使呼吸功略有降低，并且与CO水平升高有关。因此，NHF可能是辅助呼吸机械负荷增加患者通气的一种有用方法。
