Nasal High Flow to Modulate Dyspnea in Orally Intubated Patients.

Objectives: To compare dyspnea, we measured 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).

目标：为了比较呼吸困难，我们在压力支持通气和自主呼吸试验（SBT）期间，测量了插管患者在有无鼻部高流量（NHF；FiO2，21%；温度，31°C）的情况下，气道闭塞压力（P0.1）和吸气功。

Methods: Dyspnea (determined using numerical rating scale [NRS] and Mechanical Ventilation - Respiratory Distress Observational Scale [MV-RDOS] scores), P0.1, esophageal pressure, respiratory muscle EMG, and arterial blood gas were compared in intubated patients on pressure support ventilation presenting a dyspnea-NRS score higher than 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) an SBT with NHF at 0 and 50 L/min (randomized).

方法：在使用数值评分量表（NRS）和机械通气-呼吸困难观察量表（MV-RDOS）评分确定的呼吸困难、P0.1、食管压力、呼吸肌肌电图和动脉血气的比较中，对接受压力支持通气的插管患者进行了评估，这些患者在两种情况下呈现呼吸困难-NRS评分高于3：1）压力支持通气时使用NHF，流量从0 L/min开始，随后是30、50和60 L/min（后三种是随机的）；2）进行SBT时使用NHF，流量为0和50 L/min（随机）。

Measurements and Main Results: Twenty patients were included.

测量和主要结果：共有20名患者被纳入研究。

During pressure support ventilation, as compared with a dyspnea-NRS score of 5 (range = 4-6) at an NHF of 0 L/min, dyspnea-NRS scores were 3 (range = 2-6) and 3 (range = 2-5) at NHFs of 30 L/min and 50 L/min, respectively (P < 0.05).

在压力支持通气期间，与无创通气流量为0升/分钟时的呼吸困难NRS评分为5分（范围=4-6）相比，无创通气流量为30升/分钟和50升/分钟时的呼吸困难NRS评分分别为3分（范围=2-6）和3分（范围=2-5）（P < 0.05）。

However, there was no change in MV-RDOS score, P0.1, esophageal pressure, respiratory muscle EMG, and gas exchange.

然而，MV-RDOS评分、P0.1、食管压力、呼吸肌EMG和气体交换均无变化。

During the SBT, at an NHF of 50 L/min, dyspnea-NRS score and P0.1 were lower than during the SBT at an NHF of 0 L/min (P < 0.01 and P = 0.04, respectively), whereas MV-RDOS score, esophageal pressure, and respiratory muscle EMG did not change as compared with findings in an SBT with an NHF of 0 L/min.

在自主呼吸试验（SBT）期间，当使用50 L/min的鼻高流量（NHF）时，呼吸困难NRS评分和P0.1低于使用0 L/min鼻高流量时的SBT（分别为P < 0.01和P = 0.04），而MV-RDOS评分、食管压力和呼吸肌EMG与使用0 L/min鼻高流量的SBT结果相比没有变化。

Conclusions: In orally intubated patients, NHF was associated with lower dyspnea and lower respiratory drive without affecting the inspiratory work.

结论：在经口插管的患者中，鼻高流量（NHF）与较低的呼吸困难和较低的呼吸驱动相关，但不影响吸气工作。