Physiological effects of titrated oxygen via nasal high-flow cannulae in COPD exacerbations: A randomized controlled cross-over trial
Physiological effects of titrated oxygen via nasal high-flow cannulae in COPD exacerbations: A randomized controlled cross-over trial
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DOI：
10.1111/resp.13050
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发表时间：
2017-08-01
期刊：
影响因子：
6.9
通讯作者：
Beasley, Richard
中科院分区：
文献类型：
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作者：
Pilcher, Janine;Eastlake, Leonie;Beasley, Richard
背景和目的动脉二氧化碳分压升高(PaCO2)是慢性阻塞性肺疾病急性加重的重要并发症。鼻腔高流量插管(NHF)对COPD急性加重患者PaCO2的影响，以及这种治疗是否应该在这种临床情况下使用，还不太确定。目的探讨NHF对COPD急性加重期住院患者PaCO2的影响。方法采用单中心、随机对照、交叉试验的方法，对24例COPD急性加重期住院患者经标准鼻尖吸氧治疗。患者同时接受NHF(35L/min)和SNP补充氧，每次30min，并用脉搏血氧饱和度(SpO(2))测量血氧滴定以维持患者的基线血氧饱和度。干预措施按随机顺序进行，干预措施之间至少洗涤15分钟。结果NHF患者30min后经皮二氧化碳分压(PTCO2)差值低于硝普钠(-1.4 mm Hg，95%CI：-2.2to0.6)，P=0.001。30min时SpO(2)差异无统计学意义(-0.02%(95%CI：-0.8~0.7)，P=0.96)。NHF在30min时的呼吸频率下降无统计学意义(-2.0次/分(95%CI：-4.5~0.4，P=0.099)。结论短期使用NHF可使COPD急性加重期患者的经皮二氧化碳分压较硝普钠略有下降，但是否具有临床意义尚不确定。在慢性阻塞性肺疾病急性加重期患者，短期使用35L/min的高流量鼻导管与标准鼻塞相比，经皮二氧化碳分压(PTCO2)有轻微下降。
Background and objectiveIncreased arterial carbon dioxide tension (PaCO2 ) is an important complication of acute exacerbations of COPD. The effects of nasal high-flow cannulae (NHF) on PaCO2 in patients with COPD exacerbations, and whether this therapy should be used in this clinical situation, are less certain. We aimed to investigate the effect of NHF on PaCO2 in patients admitted to hospital with a COPD exacerbation.MethodsWe performed a single-centre randomized controlled cross-over trial in 24 hospital inpatients with acute exacerbations of COPD receiving oxygen via standard nasal prongs (SNPs). Patients received both supplemental oxygen via NHF (35L/min) and SNP for 30min each, with oxygen titrated to maintain the patient's baseline oxygen saturation, measured by pulse oximetry (SpO(2) ). Interventions were administered in random order with a minimum 15-min washout between interventions. The primary outcome was difference in transcutaneous carbon dioxide tension (PtCO2 ) at 30min adjusted for time zero.ResultsThe difference in PtCO2 adjusted for time zero was lower after 30min for NHF compared with SNP (-1.4mm Hg (95% CI: -2.2 to -0.6), P=0.001). There was no difference in SpO(2) at 30min (-0.02% (95% CI: -0.8 to 0.7), P=0.96). The reduction in respiratory rate for NHF at 30min was not statistically significant (-2.0 breaths/min (95% CI: -4.5 to 0.4), P=0.099).ConclusionShort-term use of NHF results in a small reduction in PtCO2 compared with SNP in patients with acute exacerbations of COPD, but whether this is clinically significant is uncertain.In patients with exacerbations of COPD, the short-term use of nasal high-flow cannulae at 35L/min results in a small reduction in transcutaneous carbon dioxide tension (PtCO2 ) compared with standard nasal prongs.