American College of Physicians, Philadelphia, Pennsylvania (A.Q., I.E.).
Northwell Health, Huntington, New York (N.F.).
Ann Intern Med. 2021 Jul;174(7):977-984. doi: 10.7326/M20-7533. Epub 2021 Apr 27.
The American College of Physicians (ACP) developed this guideline to provide clinical recommendations on the appropriate use of high-flow nasal oxygen (HFNO) in hospitalized patients for initial or postextubation management of acute respiratory failure. It is based on the best available evidence on the benefits and harms of HFNO, taken in the context of costs and patient values and preferences.
The ACP Clinical Guidelines Committee based these recommendations on a systematic review on the efficacy and safety of HFNO. The patient-centered health outcomes evaluated included all-cause mortality, hospital length of stay, 30-day hospital readmissions, hospital-acquired pneumonia, days of intubation or reintubation, intensive care unit (ICU) admission and ICU transfers, patient comfort, dyspnea, delirium, barotrauma, compromised nutrition, gastric dysfunction, functional independence at discharge, discharge disposition, and skin breakdown. This guideline was developed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) method.
The target audience is all clinicians, and the target patient population is adult patients with acute respiratory failure treated in a hospital setting (including emergency departments, hospital wards, intermediate or step-down units, and ICUs).
RECOMMENDATION 1A:
RECOMMENDATION 1B:
美国医师学院（ACP）制定本指南，旨在就高流量鼻氧（HFNO）在住院患者中的合理应用提供临床建议，适用于急性呼吸衰竭的初始或拔管后管理。本指南基于 HFNO 的疗效和安全性的最佳现有证据，同时考虑了成本以及患者的价值观和偏好。
ACP 临床指南委员会基于 HFNO 疗效和安全性的系统评价制定了这些建议。评估的以患者为中心的健康结局包括全因死亡率、住院时间、30 天内再住院率、医院获得性肺炎、插管或重新插管天数、重症监护病房（ICU）入住和 ICU 转科、患者舒适度、呼吸困难、谵妄、气压伤、营养受损、胃功能障碍、出院时的功能独立性、出院去向以及皮肤破损。本指南采用 GRADE（推荐评估、制定与评价）方法制定。
目标受众是所有临床医生，目标患者人群是在医院环境中治疗的急性呼吸衰竭成年患者（包括急诊科、医院病房、中级或降级病房以及 ICU）。
推荐 1A：
推荐 1B：
