Critical Care Department, Vall d'Hebron University Hospital, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Barcelona, Spain.
Department of Medicine, Section of Pulmonary/Critical Care, University of Chicago, Chicago, Illinois, USA.
Curr Opin Crit Care. 2019 Feb;25(1):54-62. doi: 10.1097/MCC.0000000000000570.
To summarize the recent evidence regarding the use of noninvasive strategies for de novo acute hypoxemic respiratory failure (AHRF).
New guidelines for the use of noninvasive ventilation (NIV) in acute respiratory failure have been published. In parallel, high-flow nasal cannula (HFNC) is an emerging noninvasive strategy for AHRF patients. Although some have cautioned against the use of NIV in AHRF, new encouraging data about the use of a helmet interface for NIV in acute respiratory distress syndrome may overcome the limitations of facemask NIV.
In the last two decades, the use of NIV and HFNC in patients with AHRF has considerably expanded, changing the paradigm of management of AHRF. Choice of each technique should be based according to centre experience and patient tolerability. However, when using noninvasive strategies for AHRF, it is crucial to predefine specific criteria for intubation and monitor patients closely for early detection of clinical deterioration to avoid delayed intubation.
总结新出现的无创策略在新发低氧性急性呼吸衰竭（AHRF）中的应用证据。
急性呼吸衰竭使用无创通气（NIV）的新指南已经发布。同时，高流量鼻导管（HFNC）是一种新兴的 AHRF 患者无创策略。尽管有人对 AHRF 中使用 NIV 持谨慎态度，但急性呼吸窘迫综合征中使用头盔接口进行 NIV 的新的令人鼓舞的数据可能会克服面罩 NIV 的局限性。
在过去的二十年中，NIV 和 HFNC 在 AHRF 患者中的应用已经大大扩展，改变了 AHRF 的管理模式。每种技术的选择应根据中心经验和患者的耐受性来决定。然而，当使用无创策略治疗 AHRF 时，必须预先确定插管的具体标准，并密切监测患者，以便及早发现临床恶化，避免延迟插管。
