Frat Jean-Pierre, Coudroy Rémi, Marjanovic Nicolas, Thille Arnaud W
CHU de Poitiers, Réanimation Médicale, Poitiers, France.
INSERM, CIC-1402, équipe 5 ALIVE, Poitiers, France.
Ann Transl Med. 2017 Jul;5(14):297. doi: 10.21037/atm.2017.06.52.
High-flow nasal cannula (HFNC) oxygen therapy is a recent technique delivering a high flow of heated and humidified gas. HFNC is simpler to use and apply than noninvasive ventilation (NIV) and appears to be a good alternative treatment for hypoxemic acute respiratory failure (ARF). HFNC is better tolerated than NIV, delivers high fraction of inspired oxygen (FiO), generates a low level of positive pressure and provides washout of dead space in the upper airways, thereby improving mechanical pulmonary properties and unloading inspiratory muscles during ARF. A recent multicenter randomized controlled trial showed benefits of HFNC concerning mortality and intubation in severe patients with hypoxemic ARF. In management of patients with hypoxemic ARF, NIV results have been conflicting. Despite improved oxygenation, NIV delivered with face mask may generate high tidal volumes and subsequent ventilator-induced lung injury. An approach applying NIV with a helmet, high levels of positive end-expiratory pressure (PEEP) and low pressure support (PS) levels seems to open new opportunities in patients with hypoxemic ARF. However, a large-scale randomized controlled study is needed to assess and compare this approach with HFNC.
高流量鼻导管（HFNC）氧疗是一种输送高流量温热湿化气体的新技术。与无创通气（NIV）相比，HFNC使用和应用起来更简单，似乎是低氧性急性呼吸衰竭（ARF）的一种良好替代治疗方法。HFNC比NIV耐受性更好，能提供高吸入氧分数（FiO），产生低水平的正压，并能清除上呼吸道的死腔，从而改善机械通气肺功能，并在ARF期间减轻吸气肌负荷。最近一项多中心随机对照试验显示，HFNC对重度低氧性ARF患者的死亡率和插管方面有益。在低氧性ARF患者的管理中，NIV的结果一直存在争议。尽管面罩无创通气改善了氧合，但可能会产生高潮气量并随后导致呼吸机相关性肺损伤。一种采用头盔无创通气、高水平呼气末正压（PEEP）和低压力支持（PS）水平的方法似乎为低氧性ARF患者带来了新的机会。然而，需要进行大规模随机对照研究来评估和比较这种方法与HFNC。
