Grensemann Jörn, Simon Marcel, Wachs Christian, Kluge Stefan
Klinik für Intensivmedizin, Zentrum für Anästhesiologie und Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Deutschland.
Abteilung für Pneumologie, II. Medizinische Klinik, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland.
Pneumologe (Berl). 2022;19(1):21-26. doi: 10.1007/s10405-021-00415-z. Epub 2021 Oct 5.
High-flow oxygen therapy (high flow nasal cannula, HFNC), in which an oxygen-air gas mixture is applied at flow rates between 30 and 70 L/min, is a technically simple and highly effective procedure for the treatment of hypoxemic respiratory insufficiency. Furthermore, HFNC can be used during bronchoscopy for oxygenation, before intubation for preoxygenation, and after extubation to avoid reintubation. The high gas flow prevents the patient from inspiring ambient air, allowing precise adjustment of an inspiratory oxygen fraction; furthermore, a positive end-expiratory pressure is built up by a resulting dynamic pressure, mucociliary clearance is improved by humidification and warming of the air breathed and the work of breathing is reduced by flushing the upper airways. Compared with conventional oxygen therapy, aerosol formation is not increased by HFNC; therefore, this procedure can also be used for patients with coronavirus disease 2019 (COVID-19). In hypercapnic respiratory failure the data are inconclusive and in this case noninvasive ventilation should currently be preferred instead of HFNC. It is important to remember that patients treated with HFNC are critically ill and therefore require continuous monitoring. It must be ensured that an escalation of therapy, e.g. to intubation and invasive ventilation, can be performed at any time.
高流量氧疗（高流量鼻导管，HFNC），即应用流速在30至70升/分钟之间的氧气 - 空气混合气体，是一种治疗低氧血症性呼吸功能不全的技术简单且高效的方法。此外，HFNC可在支气管镜检查期间用于给氧，在插管前用于预充氧，以及在拔管后用于避免再次插管。高气体流量可防止患者吸入周围空气，从而能够精确调整吸入氧分数；此外，由产生的动态压力形成呼气末正压，通过对吸入空气进行加湿和加温改善黏液纤毛清除功能，并通过冲洗上呼吸道减少呼吸功。与传统氧疗相比，HFNC不会增加气溶胶形成；因此，该方法也可用于2019冠状病毒病（COVID - 19）患者。在高碳酸血症性呼吸衰竭中，数据尚无定论，在这种情况下，目前应首选无创通气而非HFNC。重要的是要记住，接受HFNC治疗的患者病情危重，因此需要持续监测。必须确保能够随时进行治疗升级，例如进行插管和有创通气。
