葛志鹏,王永广,叶 飞,刘兰鹏,甘桂芬

经鼻高流量湿化氧疗是目前临床上常用的无创呼吸支持方式，与传统氧疗方式相比，其不但具有更高的氧流量以及可精准控制的湿度、温度，并且可提供一定的气道内正压，由于其特殊的生理优势和优于无创呼吸机的舒适度，目前已广泛应用在重症医学科之中。随着对高流量氧疗临床应用的研究进展，其在危重症患者中的使用目前已不再局限于呼吸衰竭，同样可以广泛应用在围插管期氧疗、床旁内镜检查等场景之中。本文对高流量氧疗在危重症患者中的应用进展进行综述，以供临床参考。

经鼻高流量湿化氧疗；危重症患者；呼吸衰竭；应用进展

[1] Nishimura M.High-Flow Nasal Cannula Oxygen Therapy in Adults:Physiological Benefits,Indication,Clinical Benefits,and Adverse Effects[J].Respir Care,2016,61(4):529-541. [2] Oczkowski S,Ergan B,Bos L,et al.ERS clinical practice guidelines:high-flow nasal cannula in acute respiratory failure[J].Eur Respir J,2022,59(4). [3] Groves N,Tobin A.High flow nasal oxygen generates positive airway pressure in adult volunteers[J].Aust Crit Care,2007,20(4):126-131. [4] Mauri T,Turrini C,Eronia N,et al.Physiologic Effects of High-Flow Nasal Cannula in Acute Hypoxemic Respiratory Failure[J].Am J Respir Crit Care Med,2017,195(9):1207-1215. [5] Drake MG.High-Flow Nasal Cannula Oxygen in Adults:An Evidence-based Assessment[J].Ann Am Thorac Soc,2018,15(2):145-155. [6] Delorme M,Bouchard PA,Simon M,et al.Effects of High-Flow Nasal Cannula on the Work of Breathing in Patients Recovering From Acute Respiratory Failure[J].Crit Care Med,2017,45(12):1981-1988. [7] Rattanajiajaroen P,Kongpolprom N.Effects of high flow nasal cannula on the coordination between swallowing and breathing in postextubation patients,a randomized crossover study[J].Crit Care,2021,25(1):365. [8] Schjorring OL,Klitgaard TL,Perner A,et al.Lower or Higher Oxygenation Targets for Acute Hypoxemic Respiratory Failure[J].N Engl J Med,2021,384(14):1301-1311. [9] Frat JP,Thille AW,Mercat A,et al.High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure.N Engl J Med.2015 Jun 4;372(23):2185-96. [10] Nagata K,Horie T,Chohnabayashi N,et al.Home High-Flow Nasal CannulaOxygen Therapy for Stable Hypercapnic COPD:A Randomized Clinical Trial.Am J Respir Crit Care Med.2022 Dec 1;206(11):1326-1335. [11] Xu Z,Zhu L,Zhan J,et al.The efficacy and safety of high-flow nasal cannula therapy in patients with COPD and type II respiratory failure:a meta-analysis and systematic review.Eur J Med Res.2021 Oct 14;26(1):122. [12] Merry AF,van Waart H,Allen SJ,et al.Ease and comfort of pre-oxygenation with high-flow nasal oxygen cannulae vs.facemask:a randomised controlled trial.Anaesthesia.2022 Dec;77(12):1346-1355. [13] Maggiore SM,Jaber S,Grieco DL,et al.High-Flow Versus VenturiMask Oxygen Therapy to Prevent Reintubation in Hypoxemic Patients after Extubation:A Multicenter Randomized Clinical Trial.Am J Respir Crit Care Med.2022 Dec 15;206(12):1452-1462. [14] Hernández G,Vaquero C,González P,et al.Effect of Postextubation High-Flow Nasal Cannula vs Conventional Oxygen Therapy on Reintubation in Low-Risk Patients:A Randomized Clinical Trial.JAMA.2016 Apr 5;315(13):1354-61. [15] Hernández G,Vaquero C,Colinas L,et al.Effect of Postextubation High-Flow Nasal Cannula vs Noninvasive Ventilation on Reintubation and Postextubation Respiratory Failure in High-Risk Patients:A Randomized Clinical Trial.JAMA.2016 Oct 18;316(15):1565-1574. [16] Wang R,Li HC,Li XY,et al.Modified high-flow nasal cannula oxygen therapy versus conventional oxygen therapy in patients undergoing bronchoscopy:a randomized clinical trial.BMC Pulm Med.2021 Nov 14;21(1):367. [17] Nay MA,Fromont L,Eugene A,et al.High-flow nasal oxygenation or standard oxygenation for gastrointestinal endoscopy with sedation in patients at risk of hypoxaemia:a multicentre randomised controlled trial(ODEPHI trial).Br J Anaesth.2021 Jul;127(1):133-142.

点击下载PDF