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Effect of Postextubation High-Flow Nasal Cannula vs Conventional Oxygen Therapy on Reintubation in Low-Risk Patients: A Randomized Clinical Trial.
拔管后高流量鼻插管与常规氧疗对低风险患者再插管的影响: 一项随机临床试验。

摘要

IMPORTANCE:Studies of mechanically ventilated critically ill patients that combine populations that are at high and low risk for reintubation suggest that conditioned high-flow nasal cannula oxygen therapy after extubation improves oxygenation compared with conventional oxygen therapy. However, conclusive data about reintubation are lacking.
OBJECTIVE:To determine whether high-flow nasal cannula oxygen therapy is superior to conventional oxygen therapy for preventing reintubation in mechanically ventilated patients at low risk for reintubation.
DESIGN, SETTING, AND PARTICIPANTS:Multicenter randomized clinical trial conducted between September 2012 and October 2014 in 7 intensive care units (ICUs) in Spain. Participants were 527 adult critical patients at low risk for reintubation who fulfilled criteria for planned extubation. Low risk for reintubation was defined as younger than 65 years; Acute Physiology and Chronic Health Evaluation II score less than 12 on day of extubation; body mass index less than 30; adequate secretions management; simple weaning; 0 or 1 comorbidity; and absence of heart failure, moderate-to-severe chronic obstructive pulmonary disease, airway patency problems, and prolonged mechanical ventilation.
INTERVENTIONS:Patients were randomized to undergo either high-flow or conventional oxygen therapy for 24 hours after extubation.
MAIN OUTCOMES AND MEASURES:The primary outcome was reintubation within 72 hours, compared with the Cochran-Mantel-Haenszel χ2 test. Secondary outcomes included postextubation respiratory failure, respiratory infection, sepsis and multiorgan failure, ICU and hospital length of stay and mortality, adverse events, and time to reintubation.
RESULTS:Of 527 patients (mean age, 51 years [range, 18-64]; 62% men), 264 received high-flow therapy and 263 conventional oxygen therapy. Reintubation within 72 hours was less common in the high-flow group (13 patients [4.9%] vs 32 [12.2%] in the conventional group; absolute difference, 7.2% [95% CI, 2.5% to 12.2%]; P = .004). Postextubation respiratory failure was less common in the high-flow group (22/264 patients [8.3%] vs 38/263 [14.4%] in the conventional group; absolute difference, 6.1% [95% CI, 0.7% to 11.6%]; P = .03). Time to reintubation was not significantly different between groups (19 hours [interquartile range, 12-28] in the high-flow group vs 15 hours [interquartile range, 9-31] in the conventional group; absolute difference, -4 [95% CI, -54 to 46]; P = .66]. No adverse effects were reported.
CONCLUSIONS AND RELEVANCE:Among extubated patients at low risk for reintubation, the use of high-flow nasal cannula oxygen compared with conventional oxygen therapy reduced the risk of reintubation within 72 hours.
TRIAL REGISTRATION:clinicaltrials.gov Identifier: NCT01191489.

译文

重要性: 对机械通气的危重病人的研究表明,与传统氧疗相比,拔管后条件性高流量鼻导管氧疗可以改善氧合。然而,缺乏关于再插管的结论性数据。
目的: 确定低再插管风险机械通气患者在预防再插管方面,高流量鼻导管氧疗是否优于常规氧疗。
设计、设置和参与者: 2012年9月至 2014年10月在西班牙 7 个重症监护病房 (ICUs) 进行的多中心随机临床试验。参与者是 527 名符合计划拔管标准的低再插管风险的成年危重病人。再次插管的低风险定义为年龄小于 65 岁; 急性生理学和慢性健康评估 II 拔管当天得分小于 12 分; 体重指数小于 30 分; 适当的分泌物管理; 单纯断奶; 0 或 1 合并症; 和无心力衰竭,中度至重度慢性阻塞性肺病,气道通畅问题和机械通气时间延长。
干预: 患者在拔管后 24 小时随机接受高流量或常规氧疗。
主要结果和措施: 主要结果是在 72 小时内再次拔管,与 Cochran-Mantel-Haenszel χ 2 检验相比。次要结果包括拔管后呼吸衰竭、呼吸道感染、败血症和多器官衰竭、 ICU 和住院时间以及死亡率、不良事件和再插管时间。
结果: 在 527 名患者中 (平均年龄,51 岁 [范围,18-64 岁); 62% 名男性),264 名接受高流量治疗,263 名接受常规氧疗。72 小时内再插管在高流量组中不太常见 (13 名患者 [4.9%] 比传统组中的 32 名 [12.2%]; 绝对差异,7.2% [95% CI, 2.5% 到 12.2%]; p   =  。 004)。拔管后呼吸衰竭在高流量组中不太常见 (22/264 例患者 [8.3%] 比常规组中的 38/263 [14.4%]; 绝对差异,6.1% [95% CI, 0.7% 到 11.6%]; p   =  。 03)。组间再插管时间无显著差异 (高流量组 19 小时 [四分位范围,12-28] 与 15 小时 [四分位范围, 9-31] 在常规组; 绝对差异,-4 [95% CI,-54 到 46]; p   =  。 66]。无不良反应报告。
结论和相关性: 在再次插管低风险的拔管患者中,与常规氧疗相比,使用高流量鼻导管吸氧降低了 72 小时内再次插管的风险。
试验注册: clinicaltrials.gov 标识符: nct01191489。

High-flow nasal cannula

重症 氧气治疗 治疗方法
概述  :  

氧气治疗是临床医学重要的治疗手段,传统的给氧方式主要有鼻导管吸氧和面罩吸氧。经鼻高流量氧疗(humidified high-flow nasal cannula,HFNC)由空氧混合器装置、主动加温装置、加热导丝单回路管路、鼻导管组成。HFNC可提供恒定的氧浓度以及最高可达60~80 L/min的流量,其输送的气体经过加温加湿,可达到37℃、100%的相对湿度。因此与传统氧疗比较,HFNC克服了湿化不足和氧浓度不稳定等局限,具有更广阔的应用前景。 作用机制首先,

High-flow   

释义   高流动,高流动性;洪流

例句   Need High Accuracy, High Flow, High Pressure, Fast Response, or All of the above?  

需要高精度,高流动性,高压力,快速响应,或以上所有?

 

nasal 英 [ˈneɪzl] 美 [ˈneɪzl]

释义   adj. 鼻的;鼻音的 n. 鼻骨;鼻音;鼻音字[ 复数 nasals ]

例句   However, nasal sprays can overcome this problem.

然而,鼻喷剂可以克服这一问题。

 

cannula 英 [ˈkænjʊlə] 美 [ˈkænjʊlə]  

释义   n. [医] 套管,[临床] 插管[ 复数 cannulae或cannulas ]

例句   Objective: To summarize the clinical application of permanent deep venous cannula.

目的:综述永久性深静脉插管的临床应用。


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