Emergency Intensive Care Ward, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, PR China.
Shenzhen People's Hospital, Shenzhen Institute of Respiratory Diseases, China.
Expert Rev Respir Med. 2020 Apr;14(4):425-433. doi: 10.1080/17476348.2020.1722642. Epub 2020 Jan 30.
: Patients with dyspnea and hypoxemia are common in emergency departments. However, it is unknown whether high-flow nasal cannula (HFNC) reduces the risk of requiring more advanced ventilation support and whether HFNC relieves dyspnea better than conventional oxygen therapy (COT).: We searched the PubMed, Cochrane Library, Ovid, and Embase databases from inception to 1 September 2019 to identify relevant-randomized controlled trials comparing the effect of HFNC with COT in emergency departments regarding the severity of dyspnea, hospitalization rate, intubation rate, and hospital mortality. We identified four studies. HFNC was associated with a lower rate of requiring more advanced ventilation. HFNC reduced the rate of dyspnea, lowered the dyspnea scale score, and decreased patients' respiratory rate significantly. However, there was insufficient evidence to show a significant effect on HFNC regarding patients' oxygenation and hospital mortality.: For patients with dyspnea and hypoxemia before hospitalization, the short-term effect of HFNC was undeniable. HFNC reduced the risk of requiring more advanced ventilation and relived dyspnea better than COT. HFNC might be considered as a first-line therapy even before making a clear diagnosis for dyspnea.More studies are needed to explore the effect of HFNC on oxygenation and patients' prognosis.
患者在急诊科中常出现呼吸困难和低氧血症。然而,尚不清楚高流量鼻导管(HFNC)是否能降低需要更高级别的通气支持的风险,以及 HFNC 是否比常规氧疗(COT)更能缓解呼吸困难。
我们检索了 PubMed、Cochrane 图书馆、Ovid 和 Embase 数据库,检索时间从建库至 2019 年 9 月 1 日,以确定比较 HFNC 与 COT 在急诊科治疗呼吸困难严重程度、住院率、插管率和院内死亡率方面的效果的相关随机对照试验。我们确定了四项研究。HFNC 与需要更高级别通气的风险降低相关。HFNC 可降低呼吸困难发生率,降低呼吸困难量表评分,并显著降低患者的呼吸频率。然而,尚无足够证据表明 HFNC 对患者的氧合和院内死亡率有显著影响。
对于需要住院的呼吸困难和低氧血症患者,HFNC 的短期效果是不可否认的。HFNC 降低了需要更高级别通气的风险,并且比 COT 更能缓解呼吸困难。HFNC 甚至可以在明确诊断呼吸困难之前,被考虑作为一线治疗方法。需要更多的研究来探索 HFNC 对氧合和患者预后的影响。