Valentine Le Stang, Mélodie Graverot, Antoine Kimmoun, Marie-Cécile Niérat, Maxens Decavèle, Thomas Similowski, Alexandre Demoule, Martin Dres
{"title":"鼻高流量调节口腔插管患者呼吸困难。","authors":"Valentine Le Stang, Mélodie Graverot, Antoine Kimmoun, Marie-Cécile Niérat, Maxens Decavèle, Thomas Similowski, Alexandre Demoule, Martin Dres","doi":"10.1164/rccm.202405-1057OC","DOIUrl":null,"url":null,"abstract":"<p><strong>Rationale: </strong>High flow therapy reduces dyspnea in acute respiratory failure but the underlying mechanisms are not fully elucidated.</p><p><strong>Objectives: </strong>To compare dyspnea, airway occlusion pressure (P<sub>0.1</sub>) and inspiratory work with and without nasal high flow (NHF, FiO<sub>2</sub> 21%, temperature 31°C) in intubated patients under pressure support ventilation and during a spontaneous breathing trial (SBT).</p><p><strong>Methods: </strong>Dyspnea (numerical rating scale, NRS and Mechanical Ventilation - Respiratory Distress Observational Scale, MV-RDOS), P<sub>0.1</sub>, esophageal pressure, respiratory muscles EMG, arterial blood gas were compared in intubated patients on pressure support ventilation presenting a dyspnea-NRS > 3 during two sequences: 1) pressure support ventilation with NHF at 0 L/min followed by 30, 50 and 60 L/min (the last three were randomized) and 2) a SBT with NHF at 0 and 50 L/min (randomized).</p><p><strong>Measurements and main results: </strong>Twenty patients were included. During pressure support ventilation, as compared to dyspnea-NRS that was 5 (4 - 6) at NHF 0 L/min, dyspnea-NRS was 3 (2 - 6) and 3 (2 - 5) at NHF 30L/min and NHF 50L/min, respectively (p<0.05). However, there was no change in MV-RDOS, P<sub>0.1</sub>, esophageal pressure, respiratory muscles EMG and gas exchange. During the SBT, at NHF 50 L/min, dyspnea-NRS and P<sub>0.1</sub> were lower than during the SBT at NHF 0 L/min (p<0.01 and p=0.04 respectively) whereas MV-RDOS, esophageal pressure, respiratory muscles EMG did not change as compared to SBT with NHF 0 L/min.</p><p><strong>Conclusions: </strong>In orally intubated patients, nasal high flow was associated with lower dyspnea and lower respiratory drive without affecting the inspiratory work.</p>","PeriodicalId":7664,"journal":{"name":"American journal of respiratory and critical care medicine","volume":" ","pages":""},"PeriodicalIF":19.3000,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Nasal High Flow to Modulate Dyspnea in Orally Intubated Patients.\",\"authors\":\"Valentine Le Stang, Mélodie Graverot, Antoine Kimmoun, Marie-Cécile Niérat, Maxens Decavèle, Thomas Similowski, Alexandre Demoule, Martin Dres\",\"doi\":\"10.1164/rccm.202405-1057OC\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Rationale: </strong>High flow therapy reduces dyspnea in acute respiratory failure but the underlying mechanisms are not fully elucidated.</p><p><strong>Objectives: </strong>To compare dyspnea, airway occlusion pressure (P<sub>0.1</sub>) and inspiratory work with and without nasal high flow (NHF, FiO<sub>2</sub> 21%, temperature 31°C) in intubated patients under pressure support ventilation and during a spontaneous breathing trial (SBT).</p><p><strong>Methods: </strong>Dyspnea (numerical rating scale, NRS and Mechanical Ventilation - Respiratory Distress Observational Scale, MV-RDOS), P<sub>0.1</sub>, esophageal pressure, respiratory muscles EMG, arterial blood gas were compared in intubated patients on pressure support ventilation presenting a dyspnea-NRS > 3 during two sequences: 1) pressure support ventilation with NHF at 0 L/min followed by 30, 50 and 60 L/min (the last three were randomized) and 2) a SBT with NHF at 0 and 50 L/min (randomized).</p><p><strong>Measurements and main results: </strong>Twenty patients were included. During pressure support ventilation, as compared to dyspnea-NRS that was 5 (4 - 6) at NHF 0 L/min, dyspnea-NRS was 3 (2 - 6) and 3 (2 - 5) at NHF 30L/min and NHF 50L/min, respectively (p<0.05). However, there was no change in MV-RDOS, P<sub>0.1</sub>, esophageal pressure, respiratory muscles EMG and gas exchange. During the SBT, at NHF 50 L/min, dyspnea-NRS and P<sub>0.1</sub> were lower than during the SBT at NHF 0 L/min (p<0.01 and p=0.04 respectively) whereas MV-RDOS, esophageal pressure, respiratory muscles EMG did not change as compared to SBT with NHF 0 L/min.</p><p><strong>Conclusions: </strong>In orally intubated patients, nasal high flow was associated with lower dyspnea and lower respiratory drive without affecting the inspiratory work.</p>\",\"PeriodicalId\":7664,\"journal\":{\"name\":\"American journal of respiratory and critical care medicine\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":19.3000,\"publicationDate\":\"2024-12-16\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"American journal of respiratory and critical care medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1164/rccm.202405-1057OC\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"American journal of respiratory and critical care medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1164/rccm.202405-1057OC","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
Nasal High Flow to Modulate Dyspnea in Orally Intubated Patients.
Rationale: High flow therapy reduces dyspnea in acute respiratory failure but the underlying mechanisms are not fully elucidated.
Objectives: To compare dyspnea, airway occlusion pressure (P0.1) and inspiratory work with and without nasal high flow (NHF, FiO2 21%, temperature 31°C) in intubated patients under pressure support ventilation and during a spontaneous breathing trial (SBT).
Methods: Dyspnea (numerical rating scale, NRS and Mechanical Ventilation - Respiratory Distress Observational Scale, MV-RDOS), P0.1, esophageal pressure, respiratory muscles EMG, arterial blood gas were compared in intubated patients on pressure support ventilation presenting a dyspnea-NRS > 3 during two sequences: 1) pressure support ventilation with NHF at 0 L/min followed by 30, 50 and 60 L/min (the last three were randomized) and 2) a SBT with NHF at 0 and 50 L/min (randomized).
Measurements and main results: Twenty patients were included. During pressure support ventilation, as compared to dyspnea-NRS that was 5 (4 - 6) at NHF 0 L/min, dyspnea-NRS was 3 (2 - 6) and 3 (2 - 5) at NHF 30L/min and NHF 50L/min, respectively (p<0.05). However, there was no change in MV-RDOS, P0.1, esophageal pressure, respiratory muscles EMG and gas exchange. During the SBT, at NHF 50 L/min, dyspnea-NRS and P0.1 were lower than during the SBT at NHF 0 L/min (p<0.01 and p=0.04 respectively) whereas MV-RDOS, esophageal pressure, respiratory muscles EMG did not change as compared to SBT with NHF 0 L/min.
Conclusions: In orally intubated patients, nasal high flow was associated with lower dyspnea and lower respiratory drive without affecting the inspiratory work.
期刊介绍：
The American Journal of Respiratory and Critical Care Medicine focuses on human biology and disease, as well as animal studies that contribute to the understanding of pathophysiology and treatment of diseases that affect the respiratory system and critically ill patients. Papers that are solely or predominantly based in cell and molecular biology are published in the companion journal, the American Journal of Respiratory Cell and Molecular Biology. The Journal also seeks to publish clinical trials and outstanding review articles on areas of interest in several forms. The State-of-the-Art review is a treatise usually covering a broad field that brings bench research to the bedside. Shorter reviews are published as Critical Care Perspectives or Pulmonary Perspectives. These are generally focused on a more limited area and advance a concerted opinion about care for a specific process. Concise Clinical Reviews provide an evidence-based synthesis of the literature pertaining to topics of fundamental importance to the practice of pulmonary, critical care, and sleep medicine. Images providing advances or unusual contributions to the field are published as Images in Pulmonary, Critical Care, Sleep Medicine and the Sciences.
A recent trend and future direction of the Journal has been to include debates of a topical nature on issues of importance in pulmonary and critical care medicine and to the membership of the American Thoracic Society. Other recent changes have included encompassing works from the field of critical care medicine and the extension of the editorial governing of journal policy to colleagues outside of the United States of America. The focus and direction of the Journal is to establish an international forum for state-of-the-art respiratory and critical care medicine.
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