Medico-surgical ICU, Assistance Publique - Hôpitaux de Paris, DMU ESPRIT, Médecine Intensive Réanimation, Hôpital Louis Mourier, 92700, Colombes, France.
Université de Paris, IAME, U1137, Inserm, 75018, Paris, France.
Intensive Care Med. 2020 Dec;46(12):2238-2247. doi: 10.1007/s00134-020-06228-7. Epub 2020 Sep 8.
Nasal high flow (NHF) has gained popularity among intensivists to manage patients with acute respiratory failure. An important literature has accompanied this evolution. In this review, an international panel of experts assessed potential benefits of NHF in different areas of acute respiratory failure management. Analyses of the physiological effects of NHF indicate flow-dependent improvement in various respiratory function parameters. These beneficial effects allow some patients with severe acute hypoxemic respiratory failure to avoid intubation and improve their outcome. They require close monitoring to not delay intubation. Such a delay may worsen outcome. The ROX index may help clinicians decide when to intubate. In immunocompromised patients, NHF reduces the need for intubation but does not impact mortality. Beneficial physiological effects of NHF have also been reported in patients with chronic respiratory failure, suggesting a possible indication in acute hypercapnic respiratory failure. When intubation is required, NHF can be used to pre-oxygenate patients either alone or in combination with non-invasive ventilation (NIV). Similarly, NHF reduces reintubation alone in low-risk patients and in combination with NIV in high-risk patients. NHF may be used in the emergency department in patients who would not be offered intubation and can be better tolerated than NIV.
经鼻高流量（NHF）在治疗急性呼吸衰竭患者方面得到了重症监护医生的广泛认可。伴随这一发展，有大量相关文献。在这篇综述中，一个国际专家小组评估了 NHF 在急性呼吸衰竭管理的不同领域的潜在益处。对 NHF 生理效应的分析表明，它可使各种呼吸功能参数随流量改善。这些有益的效果使一些患有严重急性低氧性呼吸衰竭的患者避免了插管，并改善了他们的预后。但需要密切监测，以免延误插管时机。ROX 指数可帮助临床医生决定何时进行插管。在免疫功能低下的患者中，NHF 可减少插管的需求，但不影响死亡率。NHF 在慢性呼吸衰竭患者中也有有益的生理效应，这提示其在急性高碳酸血症性呼吸衰竭中可能有一定的适应证。当需要插管时，NHF 可单独或与无创通气（NIV）联合用于预氧合患者。同样，NHF 可单独减少低危患者的再插管率，与 NIV 联合使用时可减少高危患者的再插管率。在那些不考虑插管的患者中，NHF 可在急诊科使用，而且比 NIV 更耐受。
