Bräunlich Jens, Köhler Marcus, Wirtz Hubert
Department of Respiratory Medicine, University of Leipzig, 04103 Leipzig, Germany.
J Clin Med. 2023 Sep 8;12(18):5853. doi: 10.3390/jcm12185853.
Acute hypercapnic respiratory failure has a poor prognosis in patients with interstitial lung disease (ILD). Recent data demonstrated a positive effect of nasal high-flow (NHF) in patients with acute hypoxemic respiratory failure. Preliminary data also show benefits in several hypercapnic chronic lung diseases.
The aim of this study was to characterize flow-dependent changes in mean airway pressure, breathing volumes, and breathing frequency and decreases in PCO.
Mean airway pressure was measured in the nasopharyngeal space. To evaluate breathing volumes, a polysomnographic device was used (16 patients). All subjects received 20, 30, 40, and 50 L/min and-to illustrate the effects-nCPAP and nBiPAP. Capillary blood gas analyses were performed in 25 hypercapnic ILD subjects before and 5 h after the use of NHF. Additionally, comfort and dyspnea during the use of NHF were surveyed.
NHF resulted in a small flow-dependent increase in mean airway pressure. Tidal volume was unchanged and breathing rate decreased. The calculated minute volume decreased by 20 and 30 L/min NHF breathing. In spite of this fact, hypercapnia decreased at a flow rate of 24 L/min. Additionally, an improvement in dyspnea was observed.
NHF leads to a reduction in paCO. This is most likely achieved by a washout of the respiratory tract and a reduction in functional dead space. NHF enhances the effectiveness of breathing in ILD patients by the reduction in respiratory rate. In summary, NHF works as an effective ventilatory support device in hypercapnic ILD patients.
间质性肺疾病（ILD）患者发生急性高碳酸血症性呼吸衰竭时预后较差。近期数据表明，鼻高流量（NHF）对急性低氧血症性呼吸衰竭患者有积极作用。初步数据还显示其对几种高碳酸血症性慢性肺病有益。
本研究旨在描述平均气道压、呼吸容积和呼吸频率的流量依赖性变化以及PCO₂的降低情况。
在鼻咽部测量平均气道压。为评估呼吸容积，使用了多导睡眠图设备（16例患者）。所有受试者均接受20、30、40和50L/min的流量，以及——为说明效果——无创持续气道正压通气（nCPAP）和无创双水平气道正压通气（nBiPAP）。对25例高碳酸血症性ILD患者在使用NHF前及使用后5小时进行毛细血管血气分析。此外，还对使用NHF期间的舒适度和呼吸困难情况进行了调查。
NHF导致平均气道压出现小幅度的流量依赖性增加。潮气量未变，呼吸频率降低。计算得出，在NHF呼吸流量为20和30L/min时分钟通气量降低。尽管如此，在流量为24L/min时高碳酸血症有所减轻。此外，还观察到呼吸困难有所改善。
NHF可使动脉血二氧化碳分压（PaCO₂）降低。这很可能是通过呼吸道冲洗和功能残气量减少实现的。NHF通过降低呼吸频率提高了ILD患者的呼吸效率。总之，NHF是高碳酸血症性ILD患者有效的通气支持设备。
