High Pressure versus High Flow: What Should We Target in Acute Respiratory Failure?
High Pressure versus High Flow: What Should We Target in Acute Respiratory Failure?
复制标题
高压与高流量：急性呼吸衰竭时我们应该瞄准什么？
DOI：
10.1164/rccm.201911-2196ed
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发表时间：
2020
影响因子：
24.7
通讯作者：
Yoshida Takeshi
中科院分区：
文献类型：
--
作者：
Thille Arnaud W.;Yoshida Takeshi
在这一期的Journal中，Grieco和他的同事（第303-312页）比较了高流量鼻插管（HFNC）氧合和使用头盔提供高水平压力的无创通气（NIV）。在这项生理研究中，15例急性呼吸衰竭（PaO2/FIO2, 200 mm Hg）患者采用随机交叉方式，采用流量为50 L/min的HFNC或使用高压支持水平（10 - 15 cm H2O）且呼气末正压（PEEP）至少为10 cm H2O的头盔的NIV治疗，每个阶段持续60分钟。与HFNC相比，带头盔的NIV明显改善了氧合，显著减少了呼吸困难、呼吸频率和患者的努力，而两种技术之间的舒适度和PCO2没有差异。急性低氧性呼吸衰竭在ICU的管理是具有挑战性的。在最近的临床实践指南中，讨论了与口罩一起使用NIV，但专家无法提供建议(2)。目前已知无NIV的急性呼吸衰竭患者有强烈的呼吸驱动，这类患者预后特别差（3,4）。因此，在这种特殊情况下，需要采取措施保护已经受损的肺部免受患者强烈的自发努力（即自我造成的肺损伤）的伤害(5)。此外，患者强烈的呼吸驱动与NIV提供的压力支持之间的同步可能导致高vt，这可能会使肺部恶化
In this issue of the Journal, Grieco and colleagues (pp. 303–312) compare high-flow nasal cannula (HFNC) oxygenation versus noninvasive ventilation (NIV) delivering high levels of pressure using a helmet (1). In this physiological study, 15 patients with acute respiratory failure (PaO2/FIO2, 200 mm Hg) were treated in a randomized crossover fashion by HFNC with a flow of 50 L/min or by NIV using a helmet with a high pressure-support level (10–15 cm H2O) and a positive end-expiratory pressure (PEEP) of at least 10 cm H2O, with each phase lasting 60 minutes. Compared with HFNC, NIV with a helmet markedly improved oxygenation and significantly reduced dyspnea, respiratory rate, and patient effort, whereas comfort and PCO2 did not differ between the two techniques.The management of acute hypoxemic respiratory failure in the ICU is challenging. In the most recent clinical practice guidelines, the use of NIV with a face mask was discussed, but the experts were unable to offer a recommendation (2). Patients with acute respiratory failure who have failed NIV are now known to have a vigorous respiratory drive, and such patients have a particularly poor prognosis (3, 4). Therefore, management to protect the already injured lung from the patient’s vigorous spontaneous efforts (ie, self-inflicted lung injury) is needed in this particular setting (5). Furthermore, synchronization between the patient’s intense respiratory drive to breath and the pressure support delivered by NIV may result in high VTs that may worsen lung
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DOI：
10.1164/rccm.201605-1081cp
发表时间：
2017-02-15
影响因子：
24.7
作者：
Brochard, Laurent;Slutsky, Arthur;Pesenti, Antonio
通讯作者：
Pesenti, Antonio
头盔与面罩无创通气对急性呼吸窘迫综合征患者气管插管率的影响：一项随机临床试验。
DOI：
10.1001/jama.2016.6338
发表时间：
2016-06-14
期刊：
JAMA
影响因子：
--
作者：
Patel BK;Wolfe KS;Pohlman AS;Hall JB;Kress JP
通讯作者：
Kress JP
影响因子：
2.2
作者：
Regan EA;Hokanson JE;Murphy JR;Make B;Lynch DA;Beaty TH;Curran-Everett D;Silverman EK;Crapo JD
通讯作者：
Crapo JD
影响因子：
8.8
作者：
Antonelli, M;Conti, G;Proietti, R
通讯作者：
Proietti, R
慢性气道阻塞的肺气肿型和支气管型。
影响因子：
168.9
作者：
B. Burrows;C. Fletcher;B. Heard;N. Jones;J. S. Wootliff
通讯作者：
J. S. Wootliff