经鼻高流量氧疗和无创正压通气对于肺源性中重度急性呼吸窘迫综合征患者初始治疗的效果评价

刘霜; 朱华栋; 于学忠; 徐胜勇; 徐军

doi:10.13201/j.issn.1009-5918.2020.03.001

经鼻高流量氧疗和无创正压通气对于肺源性中重度急性呼吸窘迫综合征患者初始治疗的效果评价

- 北京协和医院急诊科(北京, 100730)
基金项目:
中国医学科学院医学与健康科技创新工程(No:2017-I2M-1-009)

详细信息

通讯作者: 徐军,E-mail:Xujunfree@126.com

中图分类号: R563.8

收稿日期: 2019-08-14

Efficacy of high-flow nasal cannula oxygen and noninvasive positive pressure ventilation in the initial treatment of pulmonary moderate and severe acute respiratory distress syndrome

- Department of Emergency, Peking Union Medical College Hospital, Beijing, 100730, China

More Information

Corresponding author: XU Jun, E-mail: Xujunfree@126.com

Received Date: 14 August 2019

摘要

摘要: 目的:对比及评价经鼻高流量氧疗(HFNC)和无创正压通气(NPPV)对于肺源性中重度急性呼吸窘迫综合征(ARDS)患者的初始治疗效果。方法:采用回顾观察性研究,选择2016-01-01—2018-08-01期间因肺源性中重度ARDS入住我院急诊ICU的患者,且给予常规氧疗后低氧不能缓解。根据患者入院后最高的无创氧疗方案将患者分为经鼻高流量(HFNC)组及无创通气(NPPV)组,所有患者的无创氧疗方案选择为随机进行。主要观察指标为90 d病死率,次要观察指标为患者28 d气管插管率。结果:41例患者纳入分析,患者来自中国11个省,入院原因均为重症肺炎,入住ICU时氧合指数(PaO₂/FiO₂)均≤200 mmHg。所有患者的90 d病死率为49%(20/41),28 d气管插管率为51%(21/41)。HFNC组26例患者,90 d病死率为42%(11/26),28 d气管插管率为42%(11/26);NPPV组15例患者,90 d病死率为60%(9/15),28 d气管插管率为67%(10/15)。HFNC组和NPPV组90 d病死率及28 d气管插管率差异无统计学意义。根据患者基础免疫功能将所有患者分为非免疫抑制患者及免疫抑制患者,非免疫抑制患者共23例,其中HFNC组14例,NPPV组9例,HFNC非免疫抑制组患者90 d病死率及28 d插管率显著低于NPPV组患者(14%vs.67%,P=0.008;14%vs.67%,P=0.01)。免疫抑制患者共18例,其中HFNC组12例,NPPV组6例,使用HFNC患者的90 d病死率及28 d插管率与NPPV组患者差异无统计学意义(75%vs.50%,P=0.46;75%vs.67%,P=0.71)。结论:与NPPV比较,对于非免疫抑制肺源性中重度ARDS患者采用HFNC初始治疗可显著降低病死率及气管插管率,是一种较为理想的无创氧疗方案。
- 经鼻高流量氧疗 /
- 无创正压通气 /
- 机械通气 /
- 重症肺炎 /
- 急性呼吸窘迫综合征
Abstract: Objective:To evaluate and compare the therapeutic efficacy of HFNC and NPPV in patients with pulmonary ARDS. Method:A retrospective observational single-center study was performed patients admitted to the ICU of Peking Union Medical College Hospital for pulmonary ARDS from January 01,2016 to August 01, 2018 with oxygen index(PaO₂/FiO₂) ≤200 mmHg were selected and were randomly divided into HFNC group and NPPV group. The primary observation index was the 90-day mortality rate, and the secondary observation index was the 28-day tracheal intubation rate. Result:Forty-one patients were included. According to the patients' basic immunity status, all patients were divided into non-immunosuppressed group(n=23) and immunosuppressed group(n=18). The 90-day mortality and 28-day intubation rates of patients with HFNC were significantly lower than the ones with NPPV in non-immunosuppressed group(14% vs. 67%, P=0.008; 14% vs. 67%, P=0.01, respectively). The 90-day mortality and 28-day intubation rates of patients with HFNC were not significantly different from the ones with NPPV in immunosuppressed group(75% vs. 50%, P=0.46; 75% vs. 67%, P=0.71, respectively.).Conclusion:Compared with traditional NPPV, the use of HFNC therapy as an initial treatment for non-immunosuppressed pulmonary moderate and severe pulmonary ARDS patients may significantly reduce mortality in 90-days and intubation rate.
- high-flow nasal cannula oxygen /
- noninvasive positive pressure ventilation /
- mechanical ventilation /
- severe pneumonia /
- acute respiratory distress syndrome

HTML全文

参考文献(27)

[1]	Vincent J L,Sakr Y,Ranieri VM.Epidemiology and outcome of acute respiratory failure in intensive care unit patients[J].Crit Care Med,2003,31(4 Suppl):S296-299.
[2]	Stefan MS,Shieh MS,Pekow PS,et al.Epidemiology and outcomes of acute respiratory failure in the United States,2001 to 2009:a national survey[J].J Hosp Med,2013,8(2):76-82.
[3]	Azevedo L,Caruso P,Silva UVA,et al.Outcomes for patients with cancer admitted to the ICU requiring ventilatory support:results from a prospective multicenter study[J].Chest,2014,146(2):257-266.
[4]	Adda M,Coquet I,Darmon M,et al.Predictors of noninvasive ventilation failure in patients with hematologic malignancy and acute respiratory failure[J].Crit Care Med,2008,36(10):2766-2772.
[5]	Molina R,Bernal T,Borges M,et al.Ventilatory support in critically ill hematology patients with respiratory failure[J].Crit Care,2012,16(4):R133.
[6]	Antonelli M,Conti G,Esquinas A,et al.A multiple-center survey on the use in clinical practice of noninvasive ventilation as a first-line intervention for acute respiratory distress syndrome[J].Crit Care Med,2007,35(1):18-25.
[7]	Carrillo A,Gonzalez-Diaz G,Ferrer M,et al.Non-invasive ventilation in community-acquired pneumonia and severe acute respiratory failure[J].Intensive Care Med,2012,38(3):458-466.
[8]	Contou D,Fragnoli C,Córdoba-Izquierdo A,et al.Noninvasive ventilation for acute hypercapnic respiratory failure:intubation rate in an experienced unit[J].Respir Care,2013,58(12):2045-2052.
[9]	Demoule A,Girou E,Richard JC,et al.Benefits and risks of success or failure of noninvasive ventilation[J].Intensive Care Med,2006,32(11):1756-1765.
[10]	Schettino G,Altobelli N,Kacmarek RM.Noninvasive positive-pressure ventilation in acute respiratory failure outside clinical trials:experience at the Massachusetts General Hospital[J].Crit Care Med,2008,36(2):441-447.
[11]	Parke RL,Eccleston ML,McGuinness SP.The effects of flow on airway pressure during nasal high-flow oxygen therapy[J].Respir Care,2011,56(8):1151-1155.
[12]	Corley A,Caruana LR,Barnett AG,et al.Oxygen delivery through high-flow nasal cannulae increase end-expiratory lung volume and reduce respiratory rate in post-cardiac surgical patients[J].Br J Anaesth,2011,107(6):998-1004.
[13]	Chanques G,Riboulet F,Molinari N,et al.Comparison of three high flow oxygen therapy delivery devices:a clinical physiological cross-over study[J].Minerva Anestesiol,2013,79(12):1344-1355.
[14]	Cuquemelle E,Pham T,Papon JF,et al.Heated and humidified high-flow oxygen therapy reduces discomfort during hypoxemic respiratory failure[J].Respir Care,2012,57(10):1571-1577.
[15]	Pham TM,O'Malley L,Mayfield S,et al.The effect of high flow nasal cannula therapy on the work of breathing in infants with bronchiolitis[J].Pediatr Pulmonol,2015,50(7):713-720.
[16]	Sztrymf B,Messika J,Bertrand F,et al.Beneficial effects of humidified high flow nasal oxygen in critical care patients:a prospective pilot study[J].Intensive Care Med,2011,37(11):1780-1786.
[17]	Roca O,Riera J,Torres F,et al.High-flow oxygen therapy in acute respiratory failure[J].Respir Care,2010,55(4):408-413.
[18]	Frat JP,Coudroy R,Marjanovic N,et al.High-flow nasal oxygen therapy and noninvasive ventilation in the management of acute hypoxemic respiratory failure[J].Ann Transl Med,2017,5(14):297.
[19]	Gaunt KA,Spilman SK,Halub ME,et al.High-Flow Nasal Cannula in a Mixed Adult ICU[J].Respir Care,2015,60(10):1383-1389.
[20]	Frat JP,Thille AW,Mercat A,et al.High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure[J].N Engl J Med,2015,372(23):2185-2196.
[21]	Messika J,Ben Ahmed K,Gaudry S,et al.Use of High-Flow Nasal Cannula Oxygen Therapy in Subjects With ARDS:A 1-Year Observational Study[J].Respir Care,2015,60(2):162-169.
[22]	Thille AW,Contou D,Fragnoli C,et al.Non-invasive ventilation for acute hypoxemic respiratory failure:intubation rate and risk factors[J].Crit Care,2013,17(6):R269.
[23]	Esteban A,Frutos-Vivar F,Ferguson ND,et al.Noninvasive positive-pressure ventilation for respiratory failure after extubation[J].N Engl J Med,2004,350(24):2452-2460.
[24]	Carrillo A,Ferrer M,Gonzalez-Diaz G,et al.Noninvasive ventilation in acute hypercapnic respiratory failure caused by obesity hypoventilation syndrome and chronic obstructive pulmonary disease[J].Am J Respir Crit Care Med,2012,186(12):1279-1285.
[25]	Girault C,Ferrer M,Torres A,et al.Non-invasive ventilation in hypoxemic acute respiratory failure:is it still possible?[J].Intensive Care Med,2017,43(2):243-245.
[26]	Lee HY,Rhee CK,Lee JW.Feasibility of high-flow nasal cannula oxygen therapy for acute respiratory failure in patients with hematologic malignancies:A retrospective single-center study[J].J Crit Care,2015,30(4):773-777.
[27]	Coudroy R,Jamet A,Petua P,et al.High-flow nasal cannula oxygen therapy versus noninvasive ventilation in immunocompromised patients with acute respiratory failure:an observational cohort study[J].Ann Intensive Care,2016,6(1):45.