Lemyze M, Dupré C
Service de réanimation polyvalente, hôpital d'Arras, boulevard Besnier, 62000 Arras, France.
Service de réanimation polyvalente, hôpital d'Arras, boulevard Besnier, 62000 Arras, France.
Rev Mal Respir. 2022 Apr;39(4):367-375. doi: 10.1016/j.rmr.2022.02.061. Epub 2022 Apr 19.
High flow oxygen via nasal cannula (HFONC) has become the first-line reference symptomatic treatment for hypoxemic acute respiratory failure. This non-invasive technique can be addressed, as palliative therapeutic care, to frail patients near end-of-life with a do-not-intubate order. A distinction will be made between those with an imminent and inevitable fatal outcome (pallitative end-of-life management) and those with hope for transient clinical remission (meliorative management). This review focuses on the expected physiological benefits and technical benefits/risks incurred by HFONC use in this population. Its main purpose is to highlight the ethical principles governing the palliative management of patients in acute respiratory failure with a do-not-intubate order, and to discuss the various elements to be considered when defining the patient's palliative care plan, in a holistic, individual-centered approach.
经鼻高流量吸氧（HFONC）已成为低氧性急性呼吸衰竭的一线参考对症治疗方法。作为一种姑息性治疗手段，这种非侵入性技术可用于那些下达了不插管医嘱、临近生命末期的虚弱患者。对于那些结局即将不可避免地走向死亡的患者（临终姑息治疗管理）和那些有望实现短暂临床缓解的患者（改善性治疗管理），会有所区分。本综述聚焦于HFONC用于该人群时预期的生理益处以及所带来的技术益处/风险。其主要目的是强调指导下达不插管医嘱的急性呼吸衰竭患者姑息治疗管理的伦理原则，并以整体、以患者为中心的方法，讨论在制定患者姑息治疗计划时需要考虑的各种因素。
