Atwood Charles W, Camhi Sharon, Little Kathryn C, Paul Colleen, Schweikert Hobart, Macmillan Nicholas J, Miller Thomas L
Pulmonary Section, Veterans Administration Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.
Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
Chronic Obstr Pulm Dis. 2017 Aug 15;4(4):279-286. doi: 10.15326/jcopdf.4.4.2016.0169.
High flow nasal cannula therapy (HFNC) has been widely adopted for respiratory distress, and evidence suggests that purging dead space of the upper airway improves gas fractions in the lung. This study tests the hypothesis that HFNC with room air could be as effective as low flow oxygen in chronic obstructive pulmonary disease (COPD). Thirty-two COPD patients prescribed 1 - 2 L/min of oxygen were studied. The conditions tested consisted of a control (CTRL; no therapy), then in random order HFNC and prescribed low flow oxygen (LFO). HFNC was the highest flow tolerated up to 35 L/min without supplemental oxygen. Arterial blood gases (ABGs), respiratory rate (RR), heart rate (HR) and tidal volume (V) were measured at the end of each condition. Arterial oxygen (PaO) was greater ( < 0.001) for LFO than both HFNC and CTRL (CTRL=57.4±6.1mmHg, HFNC=58.6±8.3mmHg, LFO=72.6±10.2mmHg). HFNC reduced RR by 11% (<0.05) from CTRL and LFO (CTRL=20.2±3.8br/min, HFNC=17.9±3.3br/min, LFO=20.2±3.7br/min) with no differences in V. There were no differences between arterial carbon dioxide (PaCO) (CTRL=45.5±4.9mmHg, HFNC=45.0±5.3mmHg, LFO=46.0±3.9mmHg). HFNC resulted in a clinically relevant reduction in ventilatory effort with no change in ABG indicating a gas equilibrium effect of purging anatomical dead space. ClinicalTrials.gov ID: NCT00990210.
高流量鼻导管治疗（HFNC）已被广泛应用于治疗呼吸窘迫，有证据表明清除上呼吸道死腔可改善肺内气体成分。本研究检验了以下假设：在慢性阻塞性肺疾病（COPD）中，使用室内空气的HFNC与低流量吸氧效果相当。研究了32例医嘱吸氧流量为1-2升/分钟的COPD患者。测试条件包括对照组（CTRL；不进行治疗），然后按随机顺序进行HFNC和医嘱低流量吸氧（LFO）。HFNC是在不补充氧气的情况下耐受的最高流量，可达35升/分钟。在每种条件结束时测量动脉血气（ABG）、呼吸频率（RR）、心率（HR）和潮气量（V）。LFO组的动脉血氧分压（PaO）高于HFNC组和对照组（P<0.001）（对照组=57.4±6.1mmHg，HFNC组=58.6±8.3mmHg，LFO组=72.6±10.2mmHg）。HFNC组的RR较对照组和LFO组降低了11%（P<0.05）（对照组=20.2±3.8次/分钟，HFNC组=17.9±3.3次/分钟，LFO组=20.2±3.7次/分钟），V无差异。动脉血二氧化碳分压（PaCO）在三组间无差异（对照组=45.5±4.9mmHg，HFNC组=45.0±5.3mmHg，LFO组=46.0±3.9mmHg）。HFNC导致通气努力在临床上有意义地降低，而ABG无变化，表明清除解剖死腔有气体平衡效应。ClinicalTrials.gov标识符：NCT00990210。
