Humidified High-Flow Nasal Oxygen Utilization in Patients with Cancer at Memorial Sloan-Kettering Cancer Center
Humidified High-Flow Nasal Oxygen Utilization in Patients with Cancer at Memorial Sloan-Kettering Cancer Center
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DOI：
10.1089/jpm.2011.0005
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发表时间：
2011-07-01
影响因子：
2.8
通讯作者：
Portlock, Carol S.
中科院分区：
文献类型：
--
作者：
Epstein, Andrew S.;Hartridge-Lambert, Sidonie K.;Portlock, Carol S.
背景：呼吸系统体征和症状是治疗癌症患者的医生经常遇到的问题。长期以来，补充氧（SOx）一直用于治疗缺氧呼吸功能不全，但数据显示疗效不一。技术先进的氧气输送设备，如加湿高流量鼻氧（HHFNOx）的使用和结果模式尚不完全清楚。方法：检索机构数据库中目前使用HHFNOx装置的病例数，提取183例患者病历进行使用特征提取。结果：自2008年以来，患者在纪念斯隆凯特琳癌症中心（MSKCC）接受hfnox治疗。在我们的研究中随机选择的183例患者中，72%的患者因缺氧而在重症监护病房（ICU）接受hfnox治疗。在使用该装置期间，患者通常会改善（41%）或保持稳定（44%），而15%的患者病情下降。在研究结束时，45%的患者还活着，55%的患者已经死亡。HHFNOx的中位时间为3天（范围：1-27天）。101例（55%）患者在使用器械之前（12%）或之后（43%）均下达了不复苏（DNR）命令。这101例患者中的大多数（78%）死于MSKCC。结论：呼吸困难是癌症患者常见且重要的症状，而传统的SOx除了在少数缺氧病例和患者偏好中没有明确的依据。我们在hfnox方面的机构经验有助于了解在癌症人群中使用新医疗设备的应用和挑战。与传统输氧方法相比，HHFNOx的生理和生活质量效益应进行前瞻性研究。
Background: Respiratory signs and symptoms are commonly encountered by physicians who care for cancer patients. Supplemental oxygen (SOx) has long been used for treatment of hypoxic respiratory insufficiency, but data reveal mixed efficacy results. The use and outcome patterns of technologically advanced oxygen delivery devices, such as humidified high-flow nasal oxygen (HHFNOx), are incompletely understood.Methods: Institutional database search of the number of patient cases in which the current HHFNOx device was used, and abstraction of 183 patient medical records for usage characteristics.Results: Patients have been treated with HHFNOx at Memorial Sloan Kettering Cancer Center (MSKCC) since 2008. Of the 183 patients randomly selected for our study, 72% received HHFNOx in the intensive care unit (ICU) because of hypoxia. Patients usually improved (41%) or remained stable (44%) while on the device, whereas 15% declined. At study completion, 45% of patients were living, and 55% had died. The median time on HHFNOx was 3 days (range: 1-27). A do not resuscitate (DNR) order was present in 101 (55%) patients, either before (12%) or after (43%) device utilization. The majority (78%) of these 101 patients died at MSKCC.Conclusion: Dyspnea is a common and important symptom in cancer patients for which SOx traditionally has had no clear basis except in select cases of hypoxia and patient preference. Our institutional experience with HHFNOx contributes to the understanding of the applications and challenges surrounding the use of new medical devices in the cancer population. Physiologic and quality-of-life benefits of HHFNOx compared with traditional oxygen delivery methods should be studied prospectively.