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Effects of high-flow nasal cannula in patients with mild to moderate hypercapnia: a prospective observational study

机译：高流量鼻腔插管对轻度至中度高级菌患者的影响：预期观察研究

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Background:High-flow nasal cannula (HFNC) became a popular tool for oxygen delivery, and its use in hypercapnia patients is gaining interest. However, evidence for using HFNC in hypercapnia is still limited. Most of the clinical studies had been conducted retrospectively, and there had been conflicting reports for the effects of HFNC on hypercapnia correction in prospective studies. Therefore, more evidence is needed to understand the effect of the HFNC in hypercapnia.Methods:We conducted a multicenter prospective observational study after applying HFNC to 45 hospitalized subjects who had moderate hypercapnia (arterial partial pressure of carbon dioxide [PaCO2], 43-70 mm Hg) without severe respiratory acidosis (pH 7.30). The primary outcome was a change in PaCO2 level in the first 24 hours of HFNC use. The secondary outcomes were changes in other parameters of arterial blood gas analysis, changes in respiration rates, and clinical outcomes.Results:A decrease in partial pressure of arterial carbon dioxide was seen, and this was significant in the first hour of HFNC application (3.80 mm Hg; 95% confidence interval, 1.21-6.37; P=0.001). Reduction of carbon dioxide levels was more prominent in subjects who did not have underlying obstructive lung disease. There was a correction in pH, but no significant changes in respiratory rate, bicarbonate, and arterial partial pressure of oxygen/fraction of inspired oxygen ratio. Mechanical ventilation was not required for 93.3% (42/45) of our study population.Conclusion:We suggest that HFNC could be a safe alternative for oxygen delivery in hypercapnia patients who do not need immediate mechanical ventilation. With HFNC oxygenation, correction of hypercapnia could be expected, especially in patients who do not have obstructive lung diseases.
机译：背景：高流量鼻插管（HFNC）成为氧递送的流行工具，其在Hypercapnia患者中的使用是兴趣的。然而，在Hypercapnia中使用HFNC的证据仍然有限。大多数临床研究已经回顾性地进行了回顾性，并且HFNC对前瞻性研究中的Hypercapnia更正的影响一直存在矛盾的报道。因此，需要更多的证据来了解HFNC在Hypercapnia的影响mm hg）没有严重的呼吸酸中毒（pH <7.30）。主要结果是HFNC使用的前24小时Paco2水平的变化。次要结果是动脉血气分析，呼吸率变化和临床结果的其他参数的变化。结果：可以看到各动脉二氧化碳的分压降低，这在HFNC应用的第一小时内显着（3.80 mm hg; 95％置信区间，1.21-6.37; p = 0.001）。在没有潜水性肺病的受试者中，二氧化碳水平的减少更加突出。 pH有校正，但呼吸速率没有显着变化，碳酸氢盐和动脉部分压力的氧气/分数的激发氧比。我们的研究人群的93.3％（42/45）不需要机械通风。结论：我们建议HFNC可以是不需要立即机械通气的高曲线患者氧递送的安全替代品。通过HFNC氧合，可以预期矫正Hypercapnia，特别是在没有阻塞性肺病的患者中。

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