Misseri Giovanni, Frassanito Luciano, Simonte Rachele, Rosà Tommaso, Grieco Domenico Luca, Piersanti Alessandra, De Robertis Edoardo, Gregoretti Cesare
Fondazione Istituto "G. Giglio" Cefalù, 90015 Palermo, Italy.
Department of Emergency, Intensive Care Medicine and Anaesthesia, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00165 Rome, Italy.
J Pers Med. 2023 Dec 30;14(1):56. doi: 10.3390/jpm14010056.
Noninvasive respiratory support (NRS), including high-flow nasal oxygen therapy (HFNOT), noninvasive ventilation (NIV) and continuous positive airway pressure (CPAP), are routinely used in the perioperative period. : This narrative review provides an overview on the perioperative use of NRS. Preoperative, intraoperative, and postoperative respiratory support is discussed, along with potential future areas of research. : During induction of anesthesia, in selected patients at high risk of difficult intubation, NIV is associated with improved gas exchange and reduced risk of postoperative respiratory complications. HFNOT demonstrated an improvement in oxygenation. Evidence on the intraoperative use of NRS is limited. Compared with conventional oxygenation, HFNOT is associated with a reduced risk of hypoxemia during procedural sedation, and recent data indicate a possible role for HFNOT for intraoperative apneic oxygenation in specific surgical contexts. After extubation, "preemptive" NIV and HFNOT in unselected cohorts do not affect clinical outcome. Postoperative "curative" NIV in high-risk patients and among those exhibiting signs of respiratory failure can reduce reintubation rate, especially after abdominal surgery. Data on postoperative "curative" HFNOT are limited. : There is increasing evidence on the perioperative use of NRS. Use of NRS should be tailored based on the patient's specific characteristics and type of surgery, aimed at a personalized cost-effective approach.
无创呼吸支持（NRS），包括高流量鼻导管给氧治疗（HFNOT）、无创通气（NIV）和持续气道正压通气（CPAP），在围手术期常规使用。：本叙述性综述概述了NRS在围手术期的应用。讨论了术前、术中和术后的呼吸支持，以及潜在的未来研究领域。：在麻醉诱导期间，对于选定的插管困难高风险患者，NIV与改善气体交换及降低术后呼吸并发症风险相关。HFNOT显示出氧合改善。关于NRS术中应用的证据有限。与传统氧合相比，HFNOT与程序镇静期间低氧血症风险降低相关，最近的数据表明HFNOT在特定手术情况下对术中窒息性氧合可能发挥作用。拔管后，在未选择的队列中进行“预防性”NIV和HFNOT不影响临床结局。高危患者及出现呼吸衰竭迹象者术后进行“治疗性”NIV可降低再插管率，尤其是腹部手术后。关于术后“治疗性”HFNOT的数据有限。：关于NRS围手术期应用的证据越来越多。应根据患者的具体特征和手术类型调整NRS的使用，旨在实现个性化的成本效益方法。
