高流量氧疗:临床值得关注的问题

High-flow nasal cannula: need to be concerned

急性呼吸衰竭是以低氧血症为特征的急性呼吸功能障碍,是威胁重症患者生命的常见疾病。机械通气是纠正严重低氧血症的主要措施,随着经鼻高流量氧疗(high flow nasal cannula,HFNC)技术的不断进步,由于其具有无创、减少口鼻咽部解剖死腔、呼气末正压通气(positive end-expiratory pressure,PEEP)效应、增加呼气末肺容积和改善舒适度等优点,逐渐在临床上成为治疗呼吸衰竭的重要手段,但由于HFNC的适应证、PEEP样效应、HFNC相关性肺损伤的发生及有创通气的转换时机等问题尚不明确,需要临床医师密切关注。

Acute respiratory failure is characterized by an acute onset of hypoxemia with a high morbidiity and mortality rate in critically ill patients. Although mechanical ventilation is still the mainstay therapy for severe hypoxiemia, with the technical progress in high-flow nasal cannula (HFNC), the latter has been widely applied to the acute respiratory failure patients because of its physiological effects:reduction of anatomical dead space, delivering apositive end expiratory pressure (PEEP) effects, increasing end-expiratory lung volume and a better comfortness. However, it still needs to be concerned about the indication, the exact PEEP effect, HFNC associated lung injury and the timing of mechanical ventilation when treating acute respiratory falure patients with HFNC.