Ye Hong, Xiang Dandan, Zhu Xiangyu, Du Xiuwei, Shang Shengyun, Xu Jing, Li Yu, Cheng Yunyun, Yang Zhongfei
Department of Respiratory and Critical Care Medicine, Qilu Hospital of Shandong University Dezhou Hospital, Dezhou, China.
Department of Ultrasound Medicine, Qilu Hospital of Shandong University Dezhou Hospital, Dezhou, China.
Front Med (Lausanne). 2025 Jan 7;11:1506877. doi: 10.3389/fmed.2024.1506877. eCollection 2024.
High-flow nasal cannula (HFNC) and non-invasive ventilation (NIV) are commonly used for respiratory support. This study aims to first establish whether to use HFNC or NIV based on comfort levels, and subsequently evaluate diaphragmatic function under equivalent comfort levels to determine the optimal modality for clinical application.
A self-controlled, non-randomized study was conducted with 10 healthy respiratory physicians as participants. Each subject was exposed to different HFNC settings, including flow rates of 20, 40, and 60 L/min at both 33 and 37°C. Additionally, participants were assessed under NIV mode. Comfort levels as the primary outcome were evaluated using the Visual Numerical Scale (VNS). Meanwhile, vital signs and diaphragmatic mobility were monitored through an electrocardiograph and ultrasound.
HFNC at a flow rate of 20 L/min provided greater comfort than NIV. However, as the flow rate increased, this comfort benefit decreased. At 40 L/min, comfort levels were similar between HFNC and NIV, while at 60 L/min, HFNC was less comfortable than NIV. Notably, temperature variations between 33 and 37°C had no significant effect on comfort. In addition, under conditions of similar comfort, HFNC demonstrated slightly greater diaphragmatic mobility compared to NIV.
Our study indicated HFNC was the preferred choice for providing respiratory support at low to moderate flow rates in healthy volunteers not requiring respiratory support. By contrast, at higher flow rates, NIV discomfort was lower than HFNC discomfort.
高流量鼻导管（HFNC）和无创通气（NIV）常用于呼吸支持。本研究旨在首先根据舒适度确定是使用HFNC还是NIV，随后在同等舒适度水平下评估膈肌功能，以确定临床应用的最佳模式。
进行了一项自我对照、非随机研究，10名健康的呼吸内科医生作为参与者。每个受试者暴露于不同的HFNC设置，包括在33℃和37℃时流速分别为20、40和60L/min。此外，参与者在NIV模式下接受评估。使用视觉数字量表（VNS）评估作为主要结果的舒适度。同时，通过心电图和超声监测生命体征和膈肌活动度。
流速为20L/min的HFNC比NIV提供了更高的舒适度。然而，随着流速增加，这种舒适度优势降低。在40L/min时，HFNC和NIV的舒适度水平相似，而在60L/min时，HFNC比NIV舒适度更低。值得注意的是，33℃至37℃之间的温度变化对舒适度没有显著影响。此外，在舒适度相似的情况下，与NIV相比，HFNC的膈肌活动度略大。
我们的研究表明，对于不需要呼吸支持的健康志愿者，HFNC是低至中等流速下提供呼吸支持的首选。相比之下，在较高流速下，NIV的不适感低于HFNC的不适感。
