高流量鼻管流速对输出管输出结果的影响:一项随机对照试验
Sheng-Yuan Ruan1, Yao-Wen Kuo2, Chun-Ta Huang1
1Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Taiwan University Hospital and College of Medicine National Taiwan University, Taipei, Taiwan.
高流量鼻腔管 (HFNC) 氧气治疗的更高的流速并没有改善术后结局. 调整后的40升/分钟设置可能与60升/分钟的呼吸辅助一样有效.
科学领域:
- 关键护理医学 关键护理医学
- 呼吸系统疗法 呼吸系统疗法
- 临床试验 临床试验
背景情况:
- 高流量鼻腔管 (HFNC) 越来越多地用于术后氧化疗.
- 它有潜力降低再灌输率是公认的,但最佳的流量设置仍在争论中.
- 目前的实践通常使用30-50L/分钟,对更高设置的有效性存在疑问.
研究的目的:
- 为了比较60L/分钟与40L/分钟HFNC流量在术后护理中的有效性.
- 为了确定更高的HFNC流速是否会减少再输管或需要非侵入性通风 (NIV).
- 评估不同HFNC流速对呼吸支升级和死亡率的影响.
主要方法:
- 一项随机对照试验涉及169名被直管后的患者.
- 患者被分配在24小时内以40升/分钟或60升/分钟的速度接受HFNC.
- 主要结局是48小时内重新灌输或NIV使用的复合结果.
主要成果:
- 两组之间主要结局 (再输管或NIV使用) 没有显著差异 (22.1%与16.9%,P=.39).
- 40L/分钟组的呼吸支升级率显著更高 (27.9%与9.6%,P=.002).
- 这表明,虽然主要结果类似,但更高的流量可能会导致更多的干预.
结论:
- 设置HFNC为60L/分钟并没有显著降低与未选择患者的40L/分钟相比,重新灌输或NIV使用.
- 一个40L/分钟HFNC设置与必要的升级定位是一个可行的替代方案,固定60L/分钟设置.
- 该研究可能缺乏足够的功率来检测流速之间的较小差异.
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