Adhikari Prakash, Bhattarai Sanket, Gupta Ashish, Ali Eiman, Ali Moeez, Riad Mohamed, Mostafa Jihan A
Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
Internal Medicine, Piedmont Athens Regional Medical Center, Athens, USA.
Cureus. 2021 Feb 16;13(2):e13372. doi: 10.7759/cureus.13372.
High-flow nasal cannula (HFNC) is an open oxygen delivery system, which provides heated and humidified oxygen at a high flow (up to 60 L/min). This effect can improve mucociliary function, airway clearance, and level of comfort to the patient. It can provide controlled and adequate fraction of inspired oxygen (FiO) between 21% and 100%. Generation of end-expiratory pressure helps in carbon dioxide washout, reduction of anatomical dead space, and recruitment of collapsed alveoli, ultimately improving tissue oxygenation. The use of HFNC in acute hypoxemic respiratory failure, post-extubation period, pre-intubation period, respiratory infection, and obstructive airway disease has been extensively studied, but there are very few studies regarding its use in cardiogenic pulmonary edema. This review provides the current understanding of the physiological effect of HFNC and its application in acute cardiogenic pulmonary edema (ACPE). We conducted a literature search on PubMed using appropriate terms and reviewed relevant articles published within the last 10 years. We found that initial therapy with HFNC in ACPE patients can improve oxygenation and respiratory rate. HFNC can potentially be an alternative to non-invasive positive-pressure ventilation in terms of initial oxygen therapy in patients with ACPE. There is a need for larger prospective studies to evaluate and develop guidelines to consider the use of HFNC in patients with ACPE. We also highlight the fact that if there is no improvement in arterial blood gas parameters after HFNC therapy, initiation of invasive ventilation should not be delayed.
高流量鼻导管（HFNC）是一种开放式氧输送系统，可提供高流量（高达60升/分钟）的加热和湿化氧气。这种作用可改善患者的黏液纤毛功能、气道清除能力和舒适度。它能在21%至100%之间提供可控且充足的吸入氧分数（FiO）。呼气末正压的产生有助于二氧化碳排出、减少解剖死腔以及使萎陷肺泡复张，最终改善组织氧合。HFNC在急性低氧性呼吸衰竭、拔管后、插管前、呼吸道感染和阻塞性气道疾病中的应用已得到广泛研究，但关于其在心源性肺水肿中的应用研究却很少。本综述阐述了目前对HFNC生理效应及其在急性心源性肺水肿（ACPE）中应用的理解。我们在PubMed上使用恰当的检索词进行了文献检索，并回顾了过去10年内发表的相关文章。我们发现，ACPE患者初始使用HFNC治疗可改善氧合和呼吸频率。就ACPE患者的初始氧疗而言，HFNC可能是非侵入性正压通气的一种替代方法。需要开展更大规模的前瞻性研究来评估并制定指南，以考虑在ACPE患者中使用HFNC。我们还强调，如果HFNC治疗后动脉血气参数无改善，不应延迟有创通气的启动。
