HFT Nasal Cannula 临床研究(10)

device (something for which it is neither designed, approved for use, or ideally suited) or to persist with the “no pain, no gain” philosophy of using true CPAP devices, which, when properly used, should provide more optimal positive airway pressure but which are more cumbersome, difficult to use, and labor intensive.

假定至少设计上CPAP应提供连续的、可预见的、可控制的正气压；同时在新生儿群体中进行过大量的研究调查。为什么HHFNC尽管没有达到与CPAP一致的标准却能广泛应用并成为一种受欢迎的呼吸支持方式而且在很多案例中都优于CPAP选择是值得我们思考的。一个可能性就是易于使用的传递正气道压的次优系统比理论上更优设计但操作困难的系统更好更有效。由此推测，照顾者们使用HHFNC作为提供CPAP的一种设备，HHFNC实现其提供气道压的功能。虽然HHFNC产生的一些较高的气道压，但目前尚不清楚这种气压是不是有益于健康，或无关紧要，或压力过度，或在不同的时间段产生以上3种影响。有人建议HHFNC通过流速变化、改进的粘膜灌注或者呼吸道刺激等其他方式可能产生更另人满意的呼吸支持。虽然目前这只是一个纯粹的探索性想法。如果是真的，虽然现在缺少证据，但HHFNC完全有可能比传统的CPAP在某一类患者和疾病治疗中更加有效。另一方面，如果HHFNC的目的主要是传递气道压，那么很多选择HHFNC而非CPAP都选择回避真正需要的是新的更好的CPAP设备还是更容易操作的HHFNC设备。选择HHFNC作为产生气压的设备（有一些既没有设计、批准使用又不是理

想的匹配），或者坚持“一分耕耘，一份收获”的人生哲理而使用准确的CPAP设备，正确的使用CPAP设备能够提供更佳的正气道压，但是它更加繁琐、更难操作、需更多人力。

CONCLUSIONS 总结

With regard to the primary question posed in this review, “Is HHFNC the new and improved CPAP?” it must be concluded that HHFNC and CPAP are not one and the same, that is, that HHFNC is not a form of CPAP. This is primarily because HHFNC is neither designed nor FDA approved to provide true CPAP. The available evidence to date suggests that some positive airway pressure is indeed generated when using HHFNC, but that this pressure is inconsistent, unreliable, and unpredictable. It remains unclear if the purported benefits of HHFNC are due to this pressure effect or to other as yet unproven effects. 至于本文献中提出的主要问题“HHFNC是新型改进的CPAP吗？”我们推断出HHFNC和CPAP并不相同，即HHFNC不是CPAP的一种表现形式。其根本原因是HHFNC既不是为提供准确的CPAP而设计也没有获得FDA认证。迄今为止，有效的论证建议使用HHFNC的确产生了一些正气道压，但是这种压力是不一致的、不可靠的、不可预见的。尚不清楚的是HHFNC声称的效应是否由此压力效应或其他尚未证实的效应造成。

This primary conclusion does not imply that HHFNC is either worse than or better than CPAP as a respiratory support modality, only that they are distinct and different modalities. The secondary question that this then begs is whether HHFNC is a better alternative to CPAP in some or all of the circumstances in which CPAP may typically be used, such as primary treatment in RDS, as a postextubation modality to prevent the need for reintubation, or as a treatment for apnea of prematurity. It seems likely that, for the foreseeable future, HHFNC will be a more user-friendly modality than CPAP and will continue to be widely used. Although high-quality evidence is currently lacking to support or refute the efficacy and/or safety of HHFNC, it is anticipated that such evidence should be forthcoming in the next few years. Until this happens, HHFNC should best be regarded as a potentially valuable respiratory support modality, being easier to use with the possibility of being better tolerated with fewer adverse effects such as local trauma, but also as a potentially dangerous respiratory support modality until concerns regarding infection risk, airway pressure, and other as yet unrecognized possible adverse effects are adequately addressed.

这个基本的结论并没有意指HHFNC是一种比CPAP更差或更好的呼吸支持疗法，仅指出它们各有其独特性并属不同的治疗方式。第二个问题是在某些或所有CPAP可能作为代表性使用的情况下，例如初期治疗呼吸窘迫综合症作为预防重插管的拔管后疗法或者治疗由早产导致的呼吸暂停，HHFNC都是使用CPAP的更好选择。在可预见的未来，HHFNC似乎很可能成为一种比CPAP更易操作的治疗方案并将广泛应用于实践。虽然目前还缺乏有力的论证或HHFNC的有效性和/或安全性遭到批驳，但我们可预见在未来几年内将会得到此类论证。有了相关论证后，HHFNC可被认为是一种有潜在价值的呼吸支持疗法，操作更加容易，可能对少数负面影响，例如局部创伤，有更好的耐受性。同时，在我们关心的关于感染风险、气道压和其他尚未辨识可能存在的负面影响没有得到充分的认识解决之前，HHFNC也是一种潜在危险的呼吸支持疗法。

At this stage, based on the currently available evidence, it seems prudent to make the following recommendations: 现阶段，以现有的有效论证为依据，谨慎的做法是遵循以下推荐规范：

1 HHFNC should not be used routinely in neonatal care until adequate evidence for safety and efficacy becomes available. 1 若无对HHFNC安全性和有效性进行充分的论证则其不应作为新生儿护理中的常规设备。

2 Ideally, use should be limited to participation in well-designed clinical trials to furnish this evidence. 2理想状态是为提供论证而限制其使用范围在设计周到的临床实验上。 3 Any use of HHFNC outside of such trial settings might best be limited to somewhat larger neonates (such as those ＞1000 g in weight) and to more moderate flow rates (eg, ＜2 L/min, in particular for smaller neonates), while close attention is paid to any potential adverse outcome trends such as infection rates.

3. 实验外使用HHFNC最好将使用对象的范围定位为较大的婴儿（例如体重大于1000g）并使用更加温和的气流率（例如：＜2 L/min,尤其针对小一点的新生儿）,同时密切关注是否出现任何副作用，比如感染率等。

It is hoped that ongoing research will define and clarify specific roles for HHFNC therapy, what flow rates may be safest and most effective, and how best to integrate this intriguing modality into the current armamentarium of respiratory support in the NICU.

我们希望正在进行的研究能给HHFNC疗法的特定角色一个清晰的定义。比如，流速率什么时候是最安全有效的， …… 此处隐藏：2895字，全部文档内容请下载后查看。喜欢就下载吧 ……