Efficacy of High-Flow Oxygen by Nasal Cannula With Active Humidification in a Patient With Acute Respiratory Failure of Neuromuscular Origin

医学 鼻插管 呼吸性酸中毒 麻醉 呼吸衰竭 插管 套管 呼吸窘迫 氧气疗法 通风(建筑) 酸中毒 外科 机械工程 工程类
作者
Salvador Díaz Lobato,Miguel Angel Folgado,Angel Chapa,Sagrario Mayoralas Alises
出处
期刊:Respiratory Care [Daedalus Enterprises]
卷期号:58 (12): e164-e167 被引量:25
标识
DOI:10.4187/respcare.02115
摘要

The treatment of choice for patients with respiratory failure of neuromuscular origin, especially in patients with hypercapnic respiratory acidosis, is noninvasive ventilation (NIV). Endotracheal intubation and invasive ventilation are indicated for patients with severe respiratory compromise or failure of NIV. In recent years, high-flow oxygen therapy and active humidification devices have been introduced, and emerging evidence suggests that high-flow oxygen may be effective in various clinical settings, such as acute respiratory failure, after cardiac surgery, during sedation and analgesia, in acute heart failure, in hypoxemic respiratory distress, in do-not-intubate patients, in patients with chronic cough and copious secretions, pulmonary fibrosis, or cancer, in critical areas and the emergency department. We report on a patient with amyotrophic lateral sclerosis who arrived at the emergency department with acute hypercapnic respiratory failure. She did not tolerate NIV and refused intubation, but was treated successfully with heated, humidified oxygen via high-flow nasal cannula. Arterial blood analysis after an hour on high-flow nasal cannula showed improved pH, PaCO2, and awareness. The respiratory acidosis was corrected, and she was discharged after 5 days of hospitalization. Her response to high-flow nasal cannula was similar to that expected with NIV. We discuss the mechanisms of action of heated, humidified high-flow oxygen therapy.

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