High-Flow Oxygen through Nasal Cannula in Acute Hypoxemic Respiratory Failure
High-Flow Oxygen through Nasal Cannula in Acute Hypoxemic Respiratory Failure
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DOI：
10.1056/nejmoa1503326
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发表时间：
2015-06-04
影响因子：
158.5
通讯作者：
Robert, Rene
中科院分区：
文献类型：
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作者：
Frat, Jean-Pierre;Thille, Arnaud W.;Robert, Rene
背景急性低氧性呼吸衰竭患者是否应使用无创通气仍有争议。通过鼻插管高流量氧气治疗可能提供一种替代的患者低氧血症. METHODS我们进行了一项多中心，开放标签试验，我们随机分配患者没有高碳酸血症谁有急性低氧性呼吸衰竭和动脉氧分压的比例吸入氧的分数为300毫米汞柱或更低的高流量氧气治疗，通过面罩或无创正压通气提供的标准氧气治疗。主要结局是第28天插管的患者比例;次要结局包括重症监护室和第90天的全因死亡率以及第28天无呼吸机的天数。结果共有310名患者纳入分析。高流量氧组的插管率（主要结局）为38%（40/106例患者），标准组为47%（44/94），无创通气组为50%（55/110）（所有比较P = 0.18）。高流量氧组第28天无呼吸机天数显著更高（24 +/- 8天，标准氧组为22 +/- 10天，无创通气组为19 +/- 12天;所有比较P = 0.02）。90天时死亡的风险比为2.01（95%置信区间[CI]，1.01 - 3.99），标准氧气与高流量氧气（P = 0.046）和2.50（95% CI，1.31 - 4.78）无创通气与高流量氧疗（P = 0.006）.结论：在非高碳酸血症急性低氧性呼吸衰竭患者中，高流量氧、标准氧或无创通气治疗的插管率无显著差异。在90天死亡率方面，高流量氧治疗组有显著差异。
BACKGROUNDWhether noninvasive ventilation should be administered in patients with acute hypoxemic respiratory failure is debated. Therapy with high-flow oxygen through a nasal cannula may offer an alternative in patients with hypoxemia.METHODSWe performed a multicenter, open-label trial in which we randomly assigned patients without hypercapnia who had acute hypoxemic respiratory failure and a ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen of 300 mm Hg or less to high-flow oxygen therapy, standard oxygen therapy delivered through a face mask, or noninvasive positive-pressure ventilation. The primary outcome was the proportion of patients intubated at day 28; secondary outcomes included all-cause mortality in the intensive care unit and at 90 days and the number of ventilator-free days at day 28.RESULTSA total of 310 patients were included in the analyses. The intubation rate (primary outcome) was 38% (40 of 106 patients) in the high-flow-oxygen group, 47% (44 of 94) in the standard group, and 50% (55 of 110) in the noninvasive-ventilation group (P = 0.18 for all comparisons). The number of ventilator-free days at day 28 was significantly higher in the high-flow-oxygen group (24 +/- 8 days, vs. 22 +/- 10 in the standard-oxygen group and 19 +/- 12 in the noninvasive-ventilation group; P = 0.02 for all comparisons). The hazard ratio for death at 90 days was 2.01 (95% confidence interval [CI], 1.01 to 3.99) with standard oxygen versus high-flow oxygen (P = 0.046) and 2.50 (95% CI, 1.31 to 4.78) with noninvasive ventilation versus high-flow oxygen (P = 0.006).CONCLUSIONSIn patients with nonhypercapnic acute hypoxemic respiratory failure, treatment with high-flow oxygen, standard oxygen, or noninvasive ventilation did not result in significantly different intubation rates. There was a significant difference in favor of high-flow oxygen in 90-day mortality.