近日，法国普瓦捷大学医院中心Jean-Pierre Frat团队研究了急性低氧性呼吸衰竭使用高流量或标准氧对患者预后的影响。相关论文于2026年3月17日发表在《新英格兰医学杂志》上。

关于经高流量鼻导管吸氧与标准氧疗对急性低氧性呼吸衰竭患者插管率和死亡率的影响，目前尚缺乏相关数据。

研究组进行了一项多中心、开放标签试验，将急性低氧性呼吸衰竭患者随机分配接受高流量氧疗或标准氧疗。所有患者的动脉血氧分压与吸入氧浓度比值均≤200，呼吸频率>25次/分钟，且胸部影像学检查显示存在肺部浸润。主要结局是28天死亡率。

共有1116例患者接受了随机分组。其中1110例（高流量氧疗组556例，标准氧疗组554例）被纳入分析。高流量氧疗组28天死亡率为14.6%（556例中81例死亡），标准氧疗组为14.6%（554例中81例死亡）（差异为-0.05个百分点；95%置信区间[CI]为-4.21至4.10；P=0.98）。高流量氧疗组至28天的插管发生率为42.4%（556例中236例），标准氧疗组为48.4%（554例中268例）（差异为-5.93个百分点；95% CI为-11.78至-0.08）。在自主呼吸期间，高流量氧疗组有13例患者（2.3%）发生严重不良事件（心脏骤停或气胸），标准氧疗组有6例患者（1.1%）发生此类事件。

研究结果表明，在急性低氧性呼吸衰竭患者中，使用经高流量鼻导管吸氧并未显著降低28天死亡率。

附：英文原文

Title: High-Flow or Standard Oxygen in Acute Hypoxemic Respiratory Failure

Author: Jean-Pierre Frat, Jean-Pierre Quenot, Christophe Guitton, Rémi Coudroy, Arnaud Gacouin, Julio Badie, Alexandre Demoule, Damien Contou, Guillaume Carteaux, Stephan Ehrmann, Fabien Jarousseau, Nicholas Sedillot, Jean-Philippe Rigaud, Jean Reignier, Franois Beloncle, Anne-Florence Dureau, Alexis Ferré, Cédric Daubin, Anna Bourreau, Agathe Delbove, Gal Pradel, Abdelhamid Fatah, Gwenhael Colin, Guillaume Deniel, Olivier Lamouret, Béatrice La Combe, Gwénal Prat, Louis-Marie Galerneau, Gal Bourdin, Gautier Julien, Anas Curtiaud, Mélanie Saint-Léger, Emanuele Turbil, Faustine Reynaud, Louis Chamblet, Stéphanie Ragot, Arnaud W. Thille

Issue&Volume: 2026-03-17

Abstract:

Background

Data are needed on the effect of oxygen delivered through a high-flow nasal cannula, as compared with standard oxygen therapy, on intubation and mortality in patients with acute hypoxemic respiratory failure.

Methods

In this multicenter, open-label trial, we randomly assigned patients who had acute hypoxemic respiratory failure to receive high-flow-oxygen or standard-oxygen therapy. All the patients had a ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen of 200 or less, a respiratory rate of more than 25 breaths per minute, and pulmonary infiltrate on chest imaging. The primary outcome was death by day 28.

Results

A total of 1116 patients underwent randomization. Of these patients, 1110 (556 in the high-flow-oxygen group and 554 in the standard-oxygen group) were included in the analysis. Mortality at day 28 was 14.6% (in 81 of 556 patients) in the high-flow-oxygen group and 14.6% (in 81 of 554 patients) in the standard-oxygen group (difference, 0.05 percentage points; 95% confidence interval [CI], 4.21 to 4.10; P=0.98). The incidence of intubation by day 28 was 42.4% (in 236 of 556 patients) in the high-flow-oxygen group and 48.4% (in 268 of 554 patients) in the standard-oxygen group (difference, 5.93 percentage points; 95% CI, 11.78 to 0.08). Serious adverse events (cardiac arrest or pneumothorax) occurred during spontaneous breathing in 13 patients (2.3%) in the high-flow-oxygen group and in 6 patients (1.1%) in the standard-oxygen group.

Conclusions

Among patients with acute hypoxemic respiratory failure, the use of oxygen delivered through a high-flow nasal cannula did not significantly reduce mortality at day 28.

DOI: NJ202603170000003

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2516087