Cânulas Nasais de Alto Fluxo: Uma Alternativa de Oxigenoterapia na Insuficiência Respiratória Aguda
DOI:
https://doi.org/10.24950/rspmi/revisao/240/2/2018Palavras-chave:
Cânula, ; Insuficiência Respiratória, OxigenoterapiaResumo
A oxigenoterapia por cânulas nasais de alto fluxo representa um importante avanço nas alternativas para o suporte ventilatório não-invasivo em doentes com insuficiência respiratória aguda. Este artigo pretende rever os principais efeitos fisiológicos associados a esta técnica, bem como os estudos que sustentam a sua aplicação em diferentes etiologias.
A sua excelente tolerabilidade associada a bons resultados de eficácia na insuficiência respiratória hipoxémica poderão
torná-la em indicação de primeira linha em situações particulares como a pneumonia, nos doentes imunocomprometidos, em casos de limitação para entubação oro-traqueal ou na estratégia de desmame ventilatório. Estudos promissores têm também demonstrado boa resposta noutras causas de insuficiência respiratória e noutros contextos fora do ambiente de Cuidados Intensivos. Trata-se assim duma alternativa viável à ventilação não-invasiva, com potencial de aplicabilidade num importante conjunto de doentes integrados no espectro clínico a cargo da Medicina Interna.
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Referências
Beddoes T, Watt J. Considerations on the Medicinal uses of Factitious Airs, and on the Manner of Obtaining them in Large Quantities. Bristol: Bulgin and Rosser: 1795.
Rochwerg B, Brochard L, Elliott MW, Hess D, Hill NS, Nava S, et al. Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure. Eur Respir J. 2017 50: pii: 1602426.
Brochard L, Mancebo J, Wysocki M, Lofaso F, Conti G, Rauss A, Simonneau G, et al. Noninvasive ventilation for acute exacerbations of Chronic Obstructive Pulmonary Disease. N Engl J Med. 1995; 333:817-22.
Masip J, Betbesé AJ, Páez J, Vecilla F, Cañizares F, Padró J, et al. Non-Invasive pressure support ventilation versus conventional oxygen therapy in acute cardiogenic pulmonary oedema: a randomized trial. Lancet. 2000; 356:2126-32.
Nishimura M. High-flow nasal cannula oxygen therapy in adults. J Intensive Care. 2015; 3:15.
Markovitz GH, Colthurst J, Storer TW, Cooper CB. Effective inspired oxygen concentration measured via transtracheal and oral gas analysis. Respir Care. 2010; 55:453-9.
Nishimura M. High-flow nasal cannula oxygen therapy in adults: physiological benefits, indication, clinical benefits, and adverse effects. Respir Care. 2016 ; 61:529-41.
Gregoretti C, Confalonieri M, Navalesi P, Squadrone V, Frigerio P, Beltrame F, et al. Evaluation of patient skin breakdown and comfort with a new face mask for non-invasive ventilation: a multi-center study. Intensive Care Med. 2002 ; 28:278-84.
Nicolini A, Ferrera L, Santo M, Ferrari-Bravo M, Del Forno M, Sclifò F. Noninvasive ventilation for hypercapnic exacerbation of chronic obstructive pulmonary disease: factors related to noninvasive ventilation failure. Pol Arch Med Wewn. 2014;124:525-31.
Navalesi P, Fanfulla F, Frigerio P, Gregoretti C, Nava S. Physiologic evaluation of noninvasive mechanical ventilation delivered with three types of masks in patients with chronic hypercapnic respiratory failure. Crit Care Med. 2000; 28:1785-90.
Ozyilmaz E, Ugurlu AO, Nava S. Timing of noninvasive ventilation failure: causes, risk factors, and potential remedies. BMC Pulm Med. 2014;14:19.
Rocco M, Conti G, Alessandri E, Morelli A, Spadetta G, Laderchi A, et al. Rescue treatment for noninvasive ventilation failure due to interface intolerance with remifentanil analgosedation: a pilot study. Intensive Care Med. 2010; 36:2060-5.
Wilkinson D, Andersen C, O´Donnell CP, De Paoli AG, Manley BJ. High flow nasal cannula for respiratory support in preterm infants. Cochrane Database Syst Rev.2016 ;2:CD006405.
Mikalsen IB, Davis P, Oymar K. High flow nasal cannula in children: a literature review. Scand J Trauma Resusc Emerg Med. 2016;24:93.
Gotera C, Diaz Lobato S, Pinto T, Winck JC. Clinical evidence on high flow oxygen therapy and active humidification in adults. Rev Port Pneumol. 2013;19:217-27.
Wettstein RB,Shelledy DC,Peters JI. Delivered oxygen concentrations using low-flow and high-flow nasal cannulas. Respir Care. 2005; 50:604-9.
Ritchie JE, Williams AB, Gerard C, Hockey H. Evaluation of a humidified nasal high-flow oxygen system, using oxygraphy, capnography and measurement of upper airway pressures. Anaesth Intensive Care. 2011; 39:1103-10.
Groves N, Tobin A. High flow nasal oxygen generates positive airway pressure in adult volunteers. Aust Crit Care. 2007; 20:126-31.
Prke R, McGuinness S, Eccleston M. Nasal high-flow therapy delivers low level positive airway pressure. Br J Anaesth. 2009; 103:886-90.
Parke RL, McGuinness SP. Pressures delivered by nasal high flow oxygen during all phases of the respiratory cycle. Respir Care. 2013; 58:1621-4.
Parke RL, Bloch A, McGuinness SP. Effect of very-high-flow nasal therapy on airway pressure and end-expiratory lung impedance in healthy volunteers. Respir Care. 2015; 60:1397-403.
Parke RL, Eccleston ML, McGuinness SP. The effects of flow on airway pressure during nasal high-flow oxygen therapy. Respir Care. 2011; 56:1151-5.
Chanques G, Riboulet F, Molinari N, Carr J, Jung B, Prades A, et al. Comparison of three high flow oxygen therapy delivery devices: a clinical physiological cross-over study. Minerva Anestesiol. 2013;79:1344-55.
Corley A, Caruana LR, Barnett AG, Tronstad O, Fraser JF. Oxygen delivery through high-flow nasal cannulae increase end-expiratory lung volume and reduce respiratory rate in post-cardiac surgical patients. Br J Anaesth. 2011; 107:998-1004.
Riera J, Pérez P, Cortés J, Roca O, Masclans JR, Rello J. Effect of high-flow nasal cannula and body position on end-expiratory lung volume: a cohort study using electrical impedance tomography. Respir Care. 2013; 58:589-96.
Luo JC, Lu MS, Zhao ZH, Jiang W, Xu B, Weng L, et al. Positive End-Expiratory Pressure Effect of 3 High-Flow Nasal Cannula Devices. Respir Care.2017; 62:888-95.
Roca O, Riera J, Torres F, Masclans JR. High-flow oxygen therapy in acute respiratory failure. Respir Care. 2010; 55:408-13.
Chatila W,Nugent T,Vance G,Gaughan J,Criner GJ. The effects of high-flow vs low-flow oxygen on exercise in advanced obstructive airways disease. Chest.2004 ; 126(4):1108-15
Itagaki T, Okuda N, Tsunano Y, Kohata H, Nakataki E, Onodera M, et al. Effect of high-flow nasal cannula on thoraco-abdominal synchrony in adult critically ill patients. Respir Care. 2014; 59:70-4.
Frizzola M, Miller TL, Rodriguez ME, Zhu Y, Rojas J, Hesek A, et al. High-flow nasal cannula: impact on oxygenation and ventilation in an acute lung injury model. Pediatr Pulmonol. 2011; 46:67-74.
Biselli PJ, Kirkness JP, Grote L, Fricke K, Schwartz AR, Smith P, et al. Nasal high-flow therapy reduces work of breathing compared with oxygen during sleep in COPD and smoking controls: a prospective observational study. J Appl Physiol.2017; 122:82-8.
Spence C, Buchmann N, Jermy M. Unsteady flow in the nasal cavity with high flow therapy measured by stereoscopic PIV. Exp Fluids. 2012; 52:569- 79
Möller W, Celik G, Feng S, Bartenstein P, Meyer G, Oliver E, et al. Nasal high flow clears anatomical dead space in upper airway models. J Appl Physiol.2015; 118:1525-32.
Chanques G, Constantin JM, Sauter M, Jung B, Sebbane M, Verzilli D, et al. Discomfort associated with underhumidified high-flow oxygen therapy in critically ill patients. Intensive Care Med. 2009; 35:996-1003.
Andres D, Thurston N, Brant R, Flemons W, Fofonoff D, Ruttimann A, et al. Randomized double-blind trial of the effects of humidified compared with nonhumidified low flow oxygen therapy on the symptoms of patient. Can Respir J. 1997; 4:76-80.
Fontanari P, Burnet H, Zattara-Hartmann MC, Jammes Y. Changes in airway resistance induced by nasal inhalation of cold dry, dry, or moist air in normal individuals. J Appl Physiol .1996; 81:1739-43.
Greenspan JS, Wolfson MR, Shaffer TH. Airway responsiveness to low inspired gas temperature in preterm neonates. J Pediatr. 1991; 118:443-5.
Rouadi P, Baroody FM, Abbott D, Naureckas E, Solway J, Naclerio RM. A technique to measure the ability of the human nose to warm and humidify air. J Appl Physiol.1999; 87:400-6.
Hirsch JA, Tokayer JL, Robinson MJ, Sackner MA. Effects of dry air and subsequent humidification on tracheal mucous velocity in dogs. J Appl Physiol. 1975; 39:242-6.
Van Oostdam JC, Walker DC, Knudson K, Dirks P, Dahlby RW, Hogg JC. Effect of breathing dry air on structure and function of airways. J Appl Physiol.1986; 61:312-7.
Barbet JP, Chauveau M, Labbé S, Lockhart A. Breathing dry air causes acute epithelial damage and inflammation of the guinea pig trachea. J Appl Physiol.1988; 64:1851-7.
Kilgour E, Rankin N, Ryan S, Pack R. Mucociliary function deteriorates in the clinical range of inspired air temperature and humidity. Intensive Care Med. 2004; 30: 1491-4.
Chidekel A, Zhu Y, Wang J, Mosko JJ,R odriguez E, Shaffer TH. The effects of gas humidification with high-flow nasal cannula on cultured human airway epithelial cells. Pulm Med. 2012; 2012:380686.
Salah B, Dinh Xuan AT, Fouilladieu JL, Lockhart A, Regnard J. Nasal mucociliary transport in healthy subjects is slower when breathing dry air. Eur Respir J.1988; 1:852-5.
Chikata Y, Izawa M, Okuda N, Itagaki T, Nakataki E, Onodera M, et al. Humidification performance of two high-flow nasal cannula devices: a bench study. Respir Care. 2014; 59:1186-90.
Maggiore SM, Idone FA, Vaschetto R, Festa R, Cataldo A, Antonicelli F, et al. Nasal high-flow versus Venturi mask oxygen therapy after extubation. Effects on oxygenation, comfort, and clinical outcome. Am J Respir Crit Care Med. 2014; 190:282-8.
Roca O, Acilu MG, Caralt B, Sacanell J, Masclans JR. Humidified high flow nasal cannula supportive therapy improves outcomes in lung transplant recipients readmitted to the intensive care unit because of acute respiratory failure. Transplantation.2015; 99:1092-8.
Rittayamai N, Tscheikuna J, Praphruetkit N, Kijpinyochai S. Use of High-Flow nasal cannula for acute dyspnea and hypoxemia in the Emergency Department. Respir Care. 2015; 60:1377-82.
Nilius G, Franke KJ, Domanski U, Rühle KH, Kirkness JP, Schneider H. Effects of nasal insufflation on arterial gas exchange and breathing pattern in patients with chronic obstructive pulmonary disease and hypercapnic respiratory failure. Adv Exp Med Biol.2013; 755:27-34.
Sztrymf B, Messika J, Bertrand F, Hurel D, Leon R, Dreyfuss D, et al. Beneficial effects of humidified high flow nasal oxygen in critical care patients: a prospective pilot study. Intensive Care Med.2011; 37:1780-6.
Schwabbauer N, Berg B, Blumenstock G, Haap M, Hetzel J, Riessen R. Nasal high-flow oxygen therapy in patients with hypoxic respiratory failure: effect on functional and subjective respiratory parameters compared to conventional oxygen therapy and non-invasive ventilation (NIV). BMC Anesthesiol.2014; 14:66
Wood KE, Flaten AL, Backes WJ. Inspissated secretions: a life-threatening complication of prolonged noninvasive ventilation. Respir Care.2000; 45:491-3.
Sztrymf B, Messika J, Mayot T, Lenglet H, Dreyfuss D, Ricard JD. of high-flow nasal cannula oxygen therapy on intensive care unit patients
with acute respiratory failure: a prospective observational study. J Crit Care; 27:324.e9-13.
Parke RL,McGuinness SP,Eccleston ML. A preliminary randomized controlled trial to assess effectiveness of nasal high-flow oxygen in intensive care patients. Respir Care.2011; 56:265-70.
Frat JP, Brugiere B, Ragot S, Chatellier D, Veinstein A, Goudet V, et al. Sequential application of oxygen therapy via high-flow nasal cannula and noninvasive ventilation in acute respiratory failure: an observational pilot study. Respir Care.2015; 60:170-8.
Stéphan F, Barrucand B, Petit P, Rézaiguia-Delclaux S, Médard A, Delannoy B et al. High-flow nasal oxygen vs noninvasive positive airway pressure in hypoxemic patients after cardiothoracic surgery: A Randomized Clinical Trial. JAMA.2015; 313:2331-9.
Nagata K, Morimoto T, Fujimoto D, Otoshi T, Nakagawa A, Otsuka K, et al. Efficacy of High-Flow Nasal Cannula Therapy in Acute Hypoxemic Respiratory Failure: Decreased Use of Mechanical Ventilation. Respir Care. 2015; 60:1390-6.
Frat JP, Thille A, Mercat A, Girault C, Ragot S, Perbet S, et al. High-Flow Oxygen through Nasal Cannula in Acute Hypoxemic Respiratory Failure. N Engl J Med. 2015; 372:2185-96
Rello J, Pérez M, Roca O, Poulakou G, Souto J, Laborda C, et al. High-flow nasal therapy in adults with severe acute respiratory infection: a cohort study in patients with 2009 influenza A/H1N1v. J Crit Care.2012; 27:434-9.
Messika J, Ben Ahmed K, Gaudry S, Miguel-Montanes R, Rafat C, Sztrymf B, et al. Use of High-Flow Nasal Cannula Oxygen Therapy in Subjects With ARDS: A 1-Year Observational Study. Respir Care.2015; 60:162-9.
Makdee O, Monsomboon A, Surabenjawong U, Praphruetkit N, Chaisirin W, Chakorn T, et al. High-Flow nasal cannula versus conventional oxygen therapy in emergency department patients with cardiogenic pulmonary edema: a randomized controlled trial. Ann Emerg Med.2017; 70:465-72.
Carratalá Perales JM, Llorens P, Brouzet B, Albert Jiménez AR, Fernández-Cañadas JM,Carbajosa Dalmau J, et al. High-Flow therapy via nasal cannula in acute heart failure. Rev Esp Cardiol.2011; 64:723-5.
Roca O, Pérez-Terán P, Masclans JR, Pérez L, Galve E, Evangelista A, et al. Patients with New York Heart Association class III heart failure may benefit with high flow nasal cannula supportive therapy: high flow nasal cannula in heart failure. J Crit Care.2013; 28:741-6.
Messika J, Goutorbe P, Hajage D, Ricard JD. Severe pulmonary embolism managed with high-flow nasal cannula oxygen therapy. Eur J Emerg Med.2017; 24:230-2.
Peters SG, Holets SR, Gay PC. High-flow nasal cannula therapy in do-not-intubate patients with hypoxemic respiratory distress. Respir Care.2013; 58:597-600.
Lee HY, Rhee CK, Lee JW. Feasibility of high-flow nasal cannula oxygen therapy for acute respiratory failure in patients with hematologic malignancies: A retrospective single-center study. J Crit Care.2015; 30:773-7.
Epstein AS, Hartridge-Lambert SK, Ramaker JS, Voigt LP, Portlock CS. Humidified high-flow nasal oxygen utilization in patients with cancer at Memorial Sloan-Kettering Cancer Center. J Palliat Med.201 ; 14:835-9.
Mokart D, Geay C, Chow-Chine L, Brun JP, Faucher M, Blache JL,et al. High-flow oxygen therapy in cancer patients with acute respiratory failure. Intensive Care Med.2015; 41:2008-10.
Coudroy R, Jamet A, Petua P, Robert R, Frat JP, Thille AW. High-flow nasal cannula oxygen therapy versus noninvasive ventilation in immunocompromised patients with acute respiratory failure: an observational cohort study. Ann Intensive Care.2016; 6:45.
Lenglet H, Sztrymf B, Leroy C, Brun P, Dreyfuss D, Ricard JD. Humidified high flow nasal oxygen during respiratory failure in the emergency department: feasibility and efficacy. Respir Care.2012; 57:1873-8.
Jones PG, Kamona S, Doran O, Sawtell F, Wilsher M. Randomized controlled trial of humidified high-flow nasal oxygen for acute respiratory distress in the emergency department: The HOT-ER Study. Respir Care.2016; 61:291-9.
Pirret AM, Takerei SF, Matheson CL, Kelly M, Strickland W, Harford J. Nasal high flow oxygen therapy in the ward setting: A prospective observational study. Intensive Crit Care Nurs. 2017; S0964-3397: 30082-9.
Huang HW, Sun XM, Shi ZH, Chen GQ, Chen L, Friedrich JO, et al. Effect of high-flow nasal cannula oxygen therapy versus conventional oxygen therapy and noninvasive ventilation on reintubation rate in adult patients after extubation: a systematic review and meta-analysis of randomized controlled trials. J Intensive Care Med.2017; 885066617705118.
Monro-Somerville T, Sim M, Ruddy J, Vilas M, Gillies MA. The Effect of High-Flow Nasal Cannula Oxygen Therapy on Mortality and Intubation Rate in Acute Respiratory Failure: A Systematic Review and Meta-Analysis. Crit Care Med.2017; 45:e449-e456.
Ni YN,Luo J,Yu H,Liu D,Ni Z,Cheng J et al. Can High-flow Nasal Cannula Reduce the Rate of Endotracheal Intubation in Adult Patients With Acute Respiratory Failure Compared With Conventional Oxygen Therapy and Noninvasive Positive Pressure Ventilation?: A Systematic Review and Meta-analysis. Chest.2017 ; 151(4):764-75.
Bräunlich J, Beyer D, Mai D, Hammerschmidt S, Seyfarth HJ, Wirtz H. Effects of nasal high flow on ventilation in volunteers, COPD and idiopathic pulmonary fibrosis patients. Respiration.2013 ; 85:319-25.
Boyer A, Vargas F, Delacre M, Saint-Léger M,C louzeau B, Hilbert G. Prognostic impact of high-flow nasal cannula oxygen supply in an ICU patient with pulmonary fibrosis complicated by acute respiratory failure. Intensive Care Med.2011;37:558-9.
Díaz-Lobato S, Folgado MA, Chapa A, Mayoralas Alises S. Efficacy of high-flow oxygen by nasal cannula with active humidification in a patient with acute respiratory failure of neuromuscular origin. Respir Care.2013;58:e164-7.
Millar J, Lutton S, O´Connor P. The use of high-flow nasal oxygen therapy in the management of hypercarbic respiratory failure. Ther Adv Respir Dis.2014;8:63-4.
Tiruvoipati R, Lewis D, Haji K, Botha J. High-flow nasal oxygen vs high-flow face mask: a randomized crossover trial in extubated patients. J Crit Care.2010;25:463-8.
Parke R, McGuinness S, Dixon R, Jull A. Open-label, phase II study of routine high-flow nasal oxygen therapy in cardiac surgical patients. Br J Anaesth.2013;111:925-31.
Rittayamai N, Tscheikuna J, Rujiwit P. High-flow nasal cannula versus conventional oxygen therapy after endotracheal extubation: a randomized crossover physiologic study. Respir Care.2014;59:485-90.
Corley A,Bull T, Spooner AJ, Barnett AG, Fraser JF. Direct extubation onto high-flow nasal cannulae post-cardiac surgery versus standard treatment in patients with a BMI ≥30: a randomised controlled trial. Intensive Care Med.2015;41:887-94.
Futier E, Paugam-Burtz C, Godet T, Khoy-Ear L, Rozencwajg S ,Delay JM, et al. Effect of early postextubation high-flow nasal cannula vs conventional oxygen therapy on hypoxaemia in patients after major abdominal surgery: a French multicentre randomised controlled trial (OPERA). Intensive Care Med.2016;42:1888-98.
Hernández G,V aquero C, González P, Subira C, Frutos-Vivar F, Rialp G, et al. Effect of Postextubation High-Flow Nasal Cannula vs Conventional Oxygen Therapy on Reintubation in Low-Risk Patients: A Randomized Clinical Trial. JAMA.2016;315:1354-61.
Fernandez R, Subira C, Frutos-Vivar F, Rialp G, Laborda C, Masclans JR, et al. High-flow nasal cannula to prevent postextubation respiratory failure in high-risk non-hypercapnic patients: a randomized multicenter trial. Ann Intensive Care.2017;7:47.
Hernández G, Vaquero C, Colinas L, Cuena R, González P, Canabal A, et al. Effect of postextubation high-flow nasal cannula vs noninvasive ventilation on reintubation and postextubation respiratory failure in high-risk patients: a randomized clinical trial. JAMA.2016;316:1565-74.
Miguel-Montanes R, Hajage D, Messika J, Bertrand F, Gaudry S, Rafat C, et al. Use of high-flow nasal cannula oxygen therapy to prevent desaturation during tracheal intubation of intensive care patients with mild-to-moderate hypoxemia. Crit Care Med.2015;43:574-83.
Lomas C, Roca O, Álvarez A, Masclans JR. Fibroscopy in patients with hypoxemic respiratory insufficiency: Utility of the high-flow nasal cannula. Respir Med CME.2009;2:121–4.
Miyagi K, Haranaga S, Higa F, Tateyama M, Fujita J. Implementation of bronchoalveolar lavage using a high-flow nasal cannula in five cases of acute respiratory failure. Respir Investig.2014;52:310-4.
Simon M, Braune S, Frings D, Wiontzek AK, Klose H, Kluge S. High-flow nasal cannula oxygen versus non-invasive ventilation in patients with acute hypoxaemic respiratory failure undergoing flexible bronchoscopy--a prospective randomised trial. Crit Care.2014;18:712.
Rea H, McAuley S, Jayaram L, Garrett J, Hockey H, Storey L, et al. The clinical utility of long-term humidification therapy in chronic airway disease. Respir Med.2010;104:525-33.
Storgaard LH, Frystyck M, Hockey H, Weinreich LM. Number of exacerbations in COPD patients on LTOT treated with a nasal high flow system. Eur Respir J. 2014; 44: 4730.
Nilius G, Franke KJ, Domanski U, Rühle KH, Kirkness JP, Schneider H. Effects of nasal insufflation on arterial gas exchange and breathing pattern in patients with chronic obstructive pulmonary disease and hypercapnic respiratory failure. Adv Exp Med Biol.2013;755:27–34.
Hegde S, Prodhan P. Serious air leak syndrome complicating high-flow nasal cannula therapy: a report of 3 cases. Pediatrics.2013;131:e939-44.
Kang BJ, Koh Y, Lim CM, Huh JW, Baek S, Han M, et al. Failure of high-flow nasal cannula therapy may delay intubation and increase mortality. Intensive Care Med.2015;41:623-32.
Hyun Cho W, Ju Yeo H, Hoon Yoon S, Lee S, SooJeon D, Seong Kim Y, et al. High-Flow Nasal Cannula Therapy for Acute Hypoxemic Respiratory Failure in Adults: A Retrospective Analysis. Intern Med.2015;54:2307-13.
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