Department of Respiratory Medicine, Respiratory Disease Center, Seirei Mikatahara General Hospital, Hamamatsu, Japan.
Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan.
Respiration. 2018;96(4):323-329. doi: 10.1159/000489890. Epub 2018 Jun 28.
High-flow nasal cannula (HFNC) oxygen therapy may provide effective respiratory management of hypoxemic respiratory failure in patients with interstitial lung disease (ILD) with a do-not-intubate (DNI) order.
The aim was to assess the efficacy and tolerability of HFNC for these patients.
We retrospectively reviewed the records of patients requesting a DNI order for hypoxemic respiratory failure associated with ILD, comparing treatment with HFNC and noninvasive positive pressure ventilation (NPPV). Outcomes measured were 30-day survival, in-hospital mortality, temporary interruption and discontinuation of the treatment at the patient's request, adverse events, oral intake, and communication ability at the end of life.
A total of 84 patients (HFNC, n = 54; NPPV, n = 30) were analyzed. Neither 30-day survival (HFNC 31.5% vs. NPPV 30.0%; p = 0.86) nor in-hospital mortality (HFNC 79.6% vs. NPPV 83.3%; p = 0.78) differed significantly. The temporary interruption and discontinuation rates were significantly lower in the HFNC group than in the NPPV group (3.7 vs. 23.3%; p = 0.009 and 0 vs. 10%; p = 0.043, respectively), and that group had significantly fewer adverse events. Among patients who died in the hospital, those treated with HFNC had significantly better oral intake and ability to converse until just before death.
HFNC had a survival rate equivalent to that of NPPV and was better tolerated by patients with hypoxemic respiratory failure associated with ILD who had a DNI order. HFNC allowed patients to eat and converse until just before death, suggesting that HFNC in these patients is a reasonable palliative treatment.
高流量鼻导管（HFNC）氧疗可能为伴有不插管（DNI）医嘱的间质性肺疾病（ILD）低氧性呼吸衰竭患者提供有效的呼吸管理。
评估 HFNC 对这些患者的疗效和耐受性。
我们回顾性分析了因 ILD 相关低氧性呼吸衰竭而要求 DNI 医嘱的患者记录，比较了 HFNC 和无创正压通气（NPPV）的治疗效果。测量的结果是 30 天生存率、住院死亡率、患者要求临时中断和停止治疗、不良事件、生命终末期的口服摄入和沟通能力。
共分析了 84 例患者（HFNC 组 54 例，NPPV 组 30 例）。30 天生存率（HFNC 组 31.5% vs. NPPV 组 30.0%；p = 0.86）和住院死亡率（HFNC 组 79.6% vs. NPPV 组 83.3%；p = 0.78）均无显著差异。HFNC 组的临时中断和停止治疗的发生率明显低于 NPPV 组（3.7% vs. 23.3%；p = 0.009 和 0 比 10%；p = 0.043），且 HFNC 组的不良事件发生率更低。在住院死亡的患者中，HFNC 治疗组在死亡前具有更好的口服摄入和交流能力。
HFNC 的生存率与 NPPV 相当，对于伴有 DNI 医嘱的 ILD 低氧性呼吸衰竭患者，HFNC 耐受性更好。HFNC 使患者能够在死亡前进食和交流，这表明 HFNC 是这些患者合理的姑息治疗方法。
