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急性呼吸衰竭(ARF)是患者入住重症加强治疗病房(ICU)的主要原因之一,临床常采用气管插管及机械通气支持,以维持正常的通气及氧合功能.危重症患者拔除气管导管(拔管)后可应用的替代氧疗设备包括普通鼻导管、储氧面罩、文丘里面罩、无创呼吸机及高流量鼻导管(HFNC)等.回顾有关HFNC治疗的生理机制及其在拔管后患者中应用的研究发现,HFNC在提供高流量氧气的同时,保证了高浓度吸入氧浓度的稳定,结合其完善的气体湿化、加温功能,可极大改善拔管后患者的氧合功能,改善患者的舒适度、降低其呼吸作功,可以作为拔管后的序贯氧疗方法,对改善脱机及建立人工气道患者的预后有益.但对于非通气因素造成呼吸衰竭和难以纠正的通气障碍,HFNC的治疗效果有限.HFNC的适用人群,以及导致其应用失败的高危因素,仍需大规模的随机对照研究确定.

Acute respiratory failure (ARF) is one primary cause of intensive care unit (ICU) admittance, which is usually treated with intubation and mechanical ventilation in order to maintain a necessary ventilation and oxygenation function. After the remove of trachea tube, available oxygenation supports include nasal cannula, venturi mask, non-invasive ventilator and high flow nasal cannula (HFNC). In this articlewe reviewed the physiological mechanism related to HFNC therapy and trails about the application of HFNC in extubated patients. HFNC can provide well heated and humidified high flow gas with a high concentration of oxygen, which can improve the oxygenation and degree of comfort of patients after extubation. Furthermore, HFNC can improve the prognosis of these patients. However, HFNC has little influence on non-ventilation related factor and severe dysfunction of ventilation, so its indication and risk factor of treatment failure should be further evaluated with randomize controlled trials.