Intensive Care Unit, Jikei University Hospital, Tokyo, Japan.
Department of Clinical Engineering Technology, Jikei University Hospital, Tokyo, Japan.
Anaesth Crit Care Pain Med. 2021 Aug;40(4):100897. doi: 10.1016/j.accpm.2021.100897. Epub 2021 Jun 1.
The coronavirus disease 2019 (COVID-19) has spread globally and can cause a shortage of medical resources, in particular, mechanical ventilators. High-flow nasal cannula oxygen therapy (HFNC) and non-invasive positive pressure ventilation (NPPV) are frequently used for acute respiratory failure patients as alternatives to invasive mechanical ventilation. They are drawing attention because of a potential role to save mechanical ventilators. However, their effectiveness and risk of viral spread are unclear. The latest network meta-analysis of pre-COVID-19 trials reported that treatment with non-invasive oxygenation strategies was associated with improved survival when compared with conventional oxygen therapy. During the COVID-19 pandemic, a lot of clinical research on COVID-19 related acute respiratory failure has been reported. Several observational studies and small trials have suggested HFNC or NPPV as an alternative of standard oxygen therapy to manage COVID-19 related acute respiratory failure, provided that appropriate infection prevention is applied by health care workers to avoid risks of the virus transmission. Awake proning is an emerging strategy to optimise the management of patients with COVID-19 acute respiratory failure. However, the benefits of awake proning have yet to be assessed in properly designed clinical research. Although HFNC and NPPV are probably effective for acute respiratory failure, the safety data are mostly based on observational and experimental reports. As such, they should be implemented carefully if adequate personal protective equipment and negative pressure rooms are available.
2019 年冠状病毒病（COVID-19）在全球范围内传播，可能导致医疗资源短缺，特别是机械呼吸机。高流量鼻导管氧疗（HFNC）和无创正压通气（NPPV）经常被用于急性呼吸衰竭患者，作为有创机械通气的替代方法。由于它们具有节省机械呼吸机的潜力，因此引起了人们的关注。然而，它们的有效性和病毒传播的风险尚不清楚。在 COVID-19 之前的试验的最新网络荟萃分析报告称，与常规氧疗相比，使用非侵入性氧合策略治疗可提高生存率。在 COVID-19 大流行期间，已经报道了许多与 COVID-19 相关的急性呼吸衰竭的临床研究。几项观察性研究和小型试验表明，HFNC 或 NPPV 可作为标准氧疗的替代方法，用于管理 COVID-19 相关的急性呼吸衰竭，但医护人员应采取适当的感染预防措施，以避免病毒传播的风险。清醒俯卧位是优化 COVID-19 急性呼吸衰竭患者管理的一种新兴策略。然而，清醒俯卧位的益处尚未在适当设计的临床研究中得到评估。尽管 HFNC 和 NPPV 可能对急性呼吸衰竭有效，但安全性数据主要基于观察性和实验报告。因此，如果有足够的个人防护设备和负压室，应谨慎实施。
