CHU de Poitiers, Médecine Intensive Réanimation, Poitiers.
INSERM CIC 1402 - ALIVE, Université de Poitiers, Faculté de Médecine et Pharmacie, Poitiers, France.
Curr Opin Crit Care. 2019 Dec;25(6):591-596. doi: 10.1097/MCC.0000000000000670.
Noninvasive ventilation is strongly recommended in acute hypercapnic respiratory failure, whereas high-flow nasal oxygen therapy could be an alternative in de novo respiratory failure.
High-flow nasal oxygen may improve the outcome of patients de novo respiratory failure as compared with standard oxygen. Its success within 2 h after initiation is well predicted by a ROX index (ratio of SpO2/FiO2 to respiratory rate) greater than 4.88, as failure when less than 3.85 at 12 h after initiation. However, the superiority of high-flow nasal oxygen to standard oxygen has not been confirmed in immunocompromised patients. Although noninvasive ventilation may be deleterious through barotrauma in patients with de novo respiratory failure, its use seems to be an optimal strategy for preoxygenation before intubation in preventing severe hypoxemia in most hypoxemic patients. In mild hypoxemic patient, high-flow nasal oxygen may be more efficient than bag-valve mask in preventing severe adverse events. After anesthetic induction further positive-pressure ventilation can better secure intubation procedure than absence of ventilation.
Despite the growing use of high-flow nasal oxygen, new studies are needed to confirm its superiority to standard oxygen in de novo respiratory failure and others causes of acute respiratory failure in place of standard oxygen.
无创通气强烈推荐用于急性高碳酸血症性呼吸衰竭，而高流量鼻氧疗可能是新发呼吸衰竭的替代疗法。
与标准氧疗相比，高流量鼻氧可能改善新发呼吸衰竭患者的结局。启动后 2 小时内 ROX 指数（SpO2/FiO2 与呼吸频率的比值）大于 4.88 可很好地预测其成功，而启动后 12 小时内小于 3.85 则预示着失败。然而，高流量鼻氧在免疫功能低下患者中的优势尚未得到证实。虽然无创通气可能通过机械通气导致新发呼吸衰竭患者气压伤，但在大多数低氧血症患者中，其用于插管前预氧合似乎是预防严重低氧血症的最佳策略。在轻度低氧血症患者中，高流量鼻氧可能比球囊面罩通气更有效地预防严重不良事件。麻醉诱导后进一步的正压通气比不进行通气能更好地保证插管过程。
尽管高流量鼻氧的使用不断增加，但仍需要新的研究来证实其在新发呼吸衰竭和其他急性呼吸衰竭病因中的优势，以替代标准氧疗。
