Exhaled air dispersion during high-flow nasal cannula therapy versus CPAP via different masks
Exhaled air dispersion during high-flow nasal cannula therapy versus CPAP via different masks
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DOI：
10.1183/13993003.02339-2018
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发表时间：
2019-04-01
影响因子：
24.3
通讯作者：
Chan, Matthew T. V.
中科院分区：
文献类型：
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作者：
Hui, David S.;Chow, Benny K.;Chan, Matthew T. V.
背景：高流量鼻插管(HFNC)是一种治疗呼吸衰竭的新兴疗法，但在治疗过程中呼出的空气分散的程度尚不清楚。我们在一个有16个换气量h(-1)的隔离室中，在人体患者模拟器(HPS)上检测HFNC治疗期间呼出的空气弥散与持续正压(CPAP)。方法：HPS被编程为代表不同的肺损伤程度。CPAP通过鼻枕(Respironics Nuance Pro Gel或ResMed Swift FX)或口鼻面罩(ResMed Quattro Air)在5-20 cm H2O下进行。HFNC，加湿至37℃，以10-60 L.min(-1)递送至HPS。呼出的气流用肺内烟雾标记以供可视化，并用激光光片显示。归一化呼出的空气浓度是根据烟雾颗粒散射的光估计的。当存在严重暴露时，定义为显著暴露。结果：在正常肺条件下，经呼吸机和ResMed鼻枕将CPAP从5 cmH2O增加到20cmH2O时，平均+/-SD呼出空气沿矢状面的弥散度分别从186+/-34 mm增加到264+/-27 mm和207+/-11 mm增加到332+/-34 mm。口鼻面罩的渗漏微乎其微。当HFNC从10增加到60L.min(-1)时，平均+/-SD呼气距离从65+/-15 mm增加到172+/-33 mm。当HFNC与接口管松动时，会产生620 mm的侧向漏气。结论：只要有良好的口罩接口配合，HFNC和CPAP过程中呼出的空气通过不同的接口扩散是有限的。
Background: High-flow nasal cannula (HFNC) is an emerging therapy for respiratory failure but the extent of exhaled air dispersion during treatment is unknown. We examined exhaled air dispersion during HFNC therapy versus continuous positive airway pressure (CPAP) on a human patient simulator (HPS) in an isolation room with 16 air changes.h(-1).Methods: The HPS was programmed to represent different severity of lung injury. CPAP was delivered at 5-20 cm H2O via nasal pillows (Respironics Nuance Pro Gel or ResMed Swift FX) or an oronasal mask (ResMed Quattro Air). HFNC, humidified to 37 degrees C, was delivered at 10-60 L.min(-1) to the HPS. Exhaled airflow was marked with intrapulmonary smoke for visualisation and revealed by laser light-sheet. Normalised exhaled air concentration was estimated from the light scattered by the smoke particles. Significant exposure was defined when there was. 20% normalised smoke concentration.Results: In the normal lung condition, mean +/- SD exhaled air dispersion, along the sagittal plane, increased from 186 +/- 34 to 264 +/- 27 mm and from 207 +/- 11 to 332 +/- 34 mm when CPAP was increased from 5 to 20 cmH2O via Respironics and ResMed nasal pillows, respectively. Leakage from the oronasal mask was negligible. Mean +/- SD exhaled air distances increased from 65 +/- 15 to 172 +/- 33 mm when HFNC was increased from 10 to 60 L.min(-1). Air leakage to 620 mm occurred laterally when HFNC and the interface tube became loose.Conclusion: Exhaled air dispersion during HFNC and CPAP via different interfaces is limited provided there is good mask interface fitting.