Non-invasive ventilatory support and high-flow nasal oxygen as first-line treatment of acute hypoxemic respiratory failure and ARDS.
Non-invasive ventilatory support and high-flow nasal oxygen as first-line treatment of acute hypoxemic respiratory failure and ARDS.
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DOI：
10.1007/s00134-021-06459-2
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发表时间：
2021-08
影响因子：
38.9
通讯作者：
Antonelli M
中科院分区：
文献类型：
--
作者：
Grieco DL;Maggiore SM;Roca O;Spinelli E;Patel BK;Thille AW;Barbas CSV;de Acilu MG;Cutuli SL;Bongiovanni F;Amato M;Frat JP;Mauri T;Kress JP;Mancebo J;Antonelli M
无创呼吸支持(高流量鼻氧和无创呼吸机)在治疗急性低氧性呼吸衰竭和急性呼吸窘迫综合征中的作用尚有争议。无创支持可以改善氧合，保护肺和横隔膜，从而避免气管插管，从而预防镇静和有创机械通气的并发症。然而，肺损伤患者的自主呼吸存在这样的风险，即剧烈的吸气努力，无论是否结合机械地增加吸气气道压力，都会产生高的跨肺压波动和局部肺过度伸展。这最终会导致额外的肺损伤(患者自己造成的肺损伤)，因此在非侵入性支持试验后进行插管的患者增加了死亡率负担。通过高流量鼻氧或通过头盔界面提供持续的呼气末正压来减少吸气努力可能会降低这些风险。在这篇从生理学到病床边的回顾中，我们提供了关于无创呼吸支持策略在重症监护病房早期治疗低氧性呼吸衰竭中的作用的最新综述。对于轻度到中度低氧血症(PaO2/FiO2 >； 150 mm Hg)，非侵入性策略似乎是安全有效的，但在相当大比例的中度到重度(PaO2/FiO2 ≤ 150 mm Hg)病例中，它们可以延迟插管，增加死亡率。高流量鼻氧和头盔无创通气是重症患者一线治疗最有前途的技术。然而，没有确凿的证据表明，在中度到重度低氧血症的情况下，推荐一种方法优于其他方法。在任何治疗过程中，严格的生理监测仍然是至关重要的，以便及时发现气管内插管的需要，而不会延误保护性通气。
The role of non-invasive respiratory support (high-flow nasal oxygen and noninvasive ventilation) in the management of acute hypoxemic respiratory failure and acute respiratory distress syndrome is debated. The oxygenation improvement coupled with lung and diaphragm protection produced by non-invasive support may help to avoid endotracheal intubation, which prevents the complications of sedation and invasive mechanical ventilation. However, spontaneous breathing in patients with lung injury carries the risk that vigorous inspiratory effort, combined or not with mechanical increases in inspiratory airway pressure, produces high transpulmonary pressure swings and local lung overstretch. This ultimately results in additional lung damage (patient self-inflicted lung injury), so that patients intubated after a trial of noninvasive support are burdened by increased mortality. Reducing inspiratory effort by high-flow nasal oxygen or delivery of sustained positive end-expiratory pressure through the helmet interface may reduce these risks. In this physiology-to-bedside review, we provide an updated overview about the role of noninvasive respiratory support strategies as early treatment of hypoxemic respiratory failure in the intensive care unit. Noninvasive strategies appear safe and effective in mild-to-moderate hypoxemia (PaO2/FiO2 > 150 mmHg), while they can yield delayed intubation with increased mortality in a significant proportion of moderate-to-severe (PaO2/FiO2 ≤ 150 mmHg) cases. High-flow nasal oxygen and helmet noninvasive ventilation represent the most promising techniques for first-line treatment of severe patients. However, no conclusive evidence allows to recommend a single approach over the others in case of moderate-to-severe hypoxemia. During any treatment, strict physiological monitoring remains of paramount importance to promptly detect the need for endotracheal intubation and not delay protective ventilation.
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影响因子：
3.5
作者：
Azevedo J;Montenegro W;Leitao A;Silva M;Prazeres J;Maranhao J
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10.1164/rccm.201605-1081cp
发表时间：
2017-02-15
影响因子：
24.7
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影响因子：
9.8
作者：
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影响因子：
38.9
作者：
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