High-Flow Oxygen Administration by Nasal Cannula for Adult and Perinatal Patients
High-Flow Oxygen Administration by Nasal Cannula for Adult and Perinatal Patients
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DOI：
10.4187/respcare.01941
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发表时间：
2013-01-01
期刊：
影响因子：
2.5
通讯作者：
Ward, Jeffrey J.
中科院分区：
文献类型：
--
作者：
Ward, Jeffrey J.
自20世纪40年代引入鼻插管以来，鼻插管一直是患者提供补充氧气的常用接口。传统上，它被归类为低流量设备，能够向具有正常分钟通气量的成年人提供0.4F-IO2，流量高达6 L/分钟。然而，患者和设计之间存在相当大的性能差异，这导致随着呼吸频率的增加，F-IO2呈指数下降。鼻插管也被成功地改装用于围产期和儿科呼吸护理；由于微小体积较小，流量减少，在0.25-1 L/分钟的范围内。大约十年前，引入了高流量鼻插管(HFNC)氧疗，伴随着加热湿化系统，以防止相关的上呼吸道粘膜干燥，并增加患者的舒适感。成人治疗流量在15-40 L/分钟范围内，F-IO2可通过空气/氧气混合独立调节。HFNC还在围产期护理中发现了更多的临床应用，因为流量为2 L/分钟的分娩系统可以产生类似于鼻腔CPAP的扩张压力。临床试验中有少量但不断增加的信息支持将HFNC用作成年人的替代氧气接口，这些成年人目前存在中度低氧血症，在通过储袋面罩或类似疗法接受氧气后持续存在。临床观察报告说，与氧气面罩相比，患者更容易接受和舒适。HFNC疗法在围产期护理中也被认为是有价值的，用于治疗呼吸窘迫综合征或支持拔管后的患者，类似于鼻腔CPAP。目前，HFNC在围产期应用中的作用的研究证据仍不清楚。这篇综述将确定提出的治疗效果的机制，目前的给药设备，合理的患者应用指南，以及进一步研究的方向。
The nasal cannula has been a commonly used patient interface to provide supplemental oxygen since its introduction in the 1940s. Traditionally, it has been categorized as a low-flow device and capable of delivering a 0.4 F-IO2 with flows up to 6 L/min to adults with normal minute ventilation. However, there is considerable performance variability among patients and design, which results in an exponential decline in delivered F-IO2, as breathing frequencies increase. The nasal cannula has also been successfully adapted for use in perinatal and pediatric respiratory care; flows are reduced, in the range of 0.25-1 L/min, due to smaller minute volumes. A decade or so ago, high-flow nasal cannula (HFNC) oxygen therapy was introduced, accompanied by heated humidification systems to prevent the associated drying of upper airway mucosa and to increase patient comfort. Therapeutic flows for adults were in the 15-40 L/min range; F-IO2 could be independently adjusted with air/O-2 blending. The HFNC has also found additional clinical application in perinatal care, as delivery systems with flows > 2 L/min could create a distending pressure similar to nasal CPAP. There is a small but growing body of information from clinical trials that supports use of HFNC as an alternative oxygen interface for adults who present with moderate hypoxemia that persists after receiving oxygen by reservoir-bag masks or similar therapy. Clinical observations report greater patient acceptance and comfort versus oxygen masks. HFNC therapy has also been considered valuable in perinatal care in treating the respiratory distress syndrome or supporting patients after extubation similar to nasal CPAP. At present, research-based evidence for the role of HFNC for its perinatal applications remains unclear. This review will identify proposed mechanisms for therapeutic effectiveness, current delivery equipment, guidelines for rational patient application, and direction for further research.