High-flow nasal cannula oxygen therapy in adults.
High-flow nasal cannula oxygen therapy in adults.
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DOI：
10.1186/s40560-015-0084-5
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发表时间：
2015
影响因子：
7.1
通讯作者：
Nishimura M
中科院分区：
文献类型：
--
作者：
Nishimura M
高流量鼻插管（HFNC）氧疗包括空气/氧气混合器、主动加湿器、单个加热回路和鼻插管。它以高达60 L/min的流量输送充分加热和加湿的医用气体，并被认为具有许多生理效应：减少解剖学死腔、PEEP效应、吸入氧气的恒定分数和良好的加湿。虽然还没有大规模的随机临床试验，但它作为危重患者的创新呼吸支持已经引起了人们的关注。大多数现有数据都是在新生儿领域发表的。重症成人的证据很差;然而，医生将其应用于各种基础疾病的各种患者：低氧性呼吸衰竭、慢性阻塞性肺疾病急性加重、拔管后、插管前氧合、睡眠呼吸暂停、急性心力衰竭、有不插管命令患者，许多已发表的报告表明，HFNC降低了呼吸频率和呼吸功，并减少了患有各种基础疾病的患者对呼吸支持升级的需求。HFNC的适应症、开始和停止HFNC的时间以及治疗的逐步升级等重要问题仍有待解决。尽管存在这些问题，但HFNC氧疗是一种创新且有效的早期治疗患有各种基础疾病的呼吸衰竭成人的方法。
High-flow nasal cannula (HFNC) oxygen therapy comprises an air/oxygen blender, an active humidifier, a single heated circuit, and a nasal cannula. It delivers adequately heated and humidified medical gas at up to 60 L/min of flow and is considered to have a number of physiological effects: reduction of anatomical dead space, PEEP effect, constant fraction of inspired oxygen, and good humidification. While there have been no big randomized clinical trials, it has been gaining attention as an innovative respiratory support for critically ill patients. Most of the available data has been published in the neonatal field. Evidence with critically ill adults are poor; however, physicians apply it to a variety of patients with diverse underlying diseases: hypoxemic respiratory failure, acute exacerbation of chronic obstructive pulmonary disease, post-extubation, pre-intubation oxygenation, sleep apnea, acute heart failure, patients with do-not-intubate order, and so on. Many published reports suggest that HFNC decreases breathing frequency and work of breathing and reduces needs of escalation of respiratory support in patients with diverse underlying diseases. Some important issues remain to be resolved, such as its indication, timing of starting and stopping HFNC, and escalating treatment. Despite these issues, HFNC oxygen therapy is an innovative and effective modality for the early treatment of adults with respiratory failure with diverse underlying diseases.