Expert consensus from emergency and critical care department on the clinical application of humidified nasal high-flow humidifying oxygen therapy in adults

Title: Expert consensus from emergency and critical care department on the clinical application of humidified nasal high-flow humidifying oxygen therapy in adults
Edition: Original
Classification: Experts consensus
Field: Comprehensive guideline
Countries and regions: China
Guidelines users: 急诊科
Evidence classification method: Level of evidence Grade Ⅰ (high grade) High-quality randomized controlled clinical studies (RCT ), authoritative guidelines, and high-quality systematic reviews and meta-analysis Grade Ⅱ (medium grade) RCT studies with certain research limitations (such as no hidden grouping, no blinding, no loss to follow-up), cohort studies, case series studies, and case-control studies Grade Ⅲ (low grade) Case reports, expert opinions Recommended level A (strong recommendation) Most patients, doctors and policy makers will adopt this plan B (moderately recommended) Most people will adopt this plan, but there are still some people who do not. It is necessary to make a decision that reflects their values and wishes based on the specific situation of the patient C (weak recommendation) Insufficient evidence requires patients, doctors and policy makers to discuss and decide together
Development unit: 北京协和医院急诊科 北京急诊医学学会
Registration time: 2021-04-17
Registration number: IPGRP-2021CN095
Purpose of the guideline: 经鼻高流量湿化氧疗(humidified high-flow nasal cannula oxygen therapy,HFNC)是一种通过无需密封的导管经鼻输入加温湿化的高流量混合气体的呼吸治疗方式。HFNC 设备由空氧混合器装置、主动加温装置、加热导丝单回路管路和鼻导管组成(附图 1),可提供准确的氧浓度(21%-100%),充分加温加湿( 37℃、绝对湿度 44 mgH2O/L、相对湿度 100%),流量最高达 60-75 L/min 的气体。越来越多的证据表明[1, 2], HFNC 对于呼吸衰竭,呼吸困难有显著的临床治疗效果,并且患者的耐受性好,操作简单易学。HFNC已经与传统鼻导管氧疗(Conventional Oxygen Therapy, COT),无创正压通气(Noninvasive Positive Pressure Ventilation, NIPPV), 有创机械通气(Invasive Mechanical Ventilation, IMV)共同成为急诊急救中常用的呼吸治疗方式。 目前,国内和国际有关HFNC指南或专家共识主要有中华医学会呼吸病学分会发布的成人经鼻高流量湿化氧疗临床规范应用专家共识[3],欧洲重症监护医学学会(European Society of Intensive Care Medicine, ESICM)发布的经鼻高流量湿化氧疗在成人呼吸支持策略中的临床实践指南[4]。而国内针对HFNC在急诊急救中应用的共识和指南尚不完善。为促进国内急诊同道规范有效安全地使用HFNC,拟制定本推荐意见,作为HFNC在成人急诊临床应用的主要参考。 本共识着重解答以下几个问题:① HFNC治疗急性呼吸衰竭的急诊流程。明确 COT、HFNC、NIV在急诊救治呼吸衰竭患者时的应用关系。②在成人急诊使用HFNC时 的适应证和禁忌证。逐步扩展HFNC在急诊应用的适应证,强调禁忌证。③使用HFNC 时监测和预测治疗效果。提高HFNC治疗各类呼吸衰竭患者的安全性。