Abstract：
OBJECTIVE: High flow nasal cannula (HFNC) oxygen therapy is frequently used following extubation. A case report, utilizing an innovative medical technology (The smART + Platform, ART MEDICAL Ltd., Netanya, Israel) that enables the detection of gastric refluxes and gastric residual volumes (GRV), has suggested that HFNC may be associated with increased reflux events and GRV. This study measured reflux events and GRV using smART+ in mechanically ventilated patients before and after extubation while they were receiving HFNC therapy. We aim to show if there is a significant difference in reflux events and GRV between HFNC users and mechanically ventilated patients.
METHODS: This is a post hoc analysis examines data of a randomized controlled trial (RCT) involving critically ill adult patients who received enteral nutrition through the smART + Platform. The study was approved by the local ethics committee. We compared the frequency and amplitude of reflux events and GRV in mechanically ventilated patients. These parameters were assessed both 3 h before extubation and subsequently after extubation when the patients were connected to HFNC. Patients served as their own controls. To evaluate the differences between the pre- and post-extubation measurements, we applied a parametric paired t-test.
RESULTS: Ten patients (mean age of 58 years; mean APACHE II score 22; mean 3.9 days of mechanical ventilation) were included. Three hours prior extubation the mean GRV was 4.1 ml/h compared to 14.03 ml/h on HFNC (p = 0.004). The mean frequency of major reflux events was 2.33/h in ventilated patients versus 4.4/h in the HFNC patients (p = 0.73). The mean frequency of major reflux events was 9.17/h in ventilated patients versus 9.83/h in HFNC patients (p = 0.14).
CONCLUSIONS: Leveraging the smART + Platform, we demonstrated that the use of HFNC significantly increases GRV compared with patients on mechanical ventilation and may increase the frequency of major reflux events, thereby increasing the risk of aspiration. Further studies are required to support our conclusions.
METHODS: This is a post hoc analysis examines data of a randomized controlled trial (RCT) involving critically ill adult patients who received enteral nutrition through the smART + Platform. The study was approved by the local ethics committee. We compared the frequency and amplitude of reflux events and GRV in mechanically ventilated patients. These parameters were assessed both 3 h before extubation and subsequently after extubation when the patients were connected to HFNC. Patients served as their own controls. To evaluate the differences between the pre- and post-extubation measurements, we applied a parametric paired t-test.
RESULTS: Ten patients (mean age of 58 years; mean APACHE II score 22; mean 3.9 days of mechanical ventilation) were included. Three hours prior extubation the mean GRV was 4.1 ml/h compared to 14.03 ml/h on HFNC (p = 0.004). The mean frequency of major reflux events was 2.33/h in ventilated patients versus 4.4/h in the HFNC patients (p = 0.73). The mean frequency of major reflux events was 9.17/h in ventilated patients versus 9.83/h in HFNC patients (p = 0.14).
CONCLUSIONS: Leveraging the smART + Platform, we demonstrated that the use of HFNC significantly increases GRV compared with patients on mechanical ventilation and may increase the frequency of major reflux events, thereby increasing the risk of aspiration. Further studies are required to support our conclusions.
摘要：
目的：拔管后经常使用高流量鼻套管（HFNC）氧疗。一个病例报告,利用创新的医疗技术(smART+平台，艺术医疗有限公司内坦亚,以色列），可以检测胃反流和胃残留量（GRV），提示HFNC可能与反流事件和GRV增加有关。这项研究在接受HFNC治疗的机械通气患者拔管前后使用smART测量了反流事件和GRV。我们旨在显示HFNC使用者和机械通气患者之间的反流事件和GRV是否存在显着差异。
方法：这是一项事后分析，检查了一项涉及通过smART+平台接受肠内营养的危重成年患者的随机对照试验（RCT）的数据。该研究得到当地伦理委员会的批准。我们比较了机械通气患者反流事件和GRV的频率和幅度。在拔管前3小时和拔管后，当患者连接到HFNC时，都对这些参数进行了评估。患者作为自己的对照。为了评估拔管前和拔管后测量之间的差异，我们应用了参数配对t检验。
结果：包括10例患者（平均年龄58岁；平均APACHEII评分22；平均机械通气3.9天）。拔管前3小时，平均GRV为4.1ml/h，而HFNC为14.03ml/h（p=0.004）。通气患者的主要反流事件的平均频率为2.33/h，而HFNC患者为4.4/h（p=0.73）。通气患者的主要反流事件的平均频率为9.17/h，而HFNC患者为9.83/h（p=0.14）。
结论：利用smART+平台，我们证明，与机械通气患者相比，使用HFNC显着增加GRV，并可能增加主要反流事件的频率，从而增加了误吸的风险。需要进一步的研究来支持我们的结论。
方法：这是一项事后分析，检查了一项涉及通过smART+平台接受肠内营养的危重成年患者的随机对照试验（RCT）的数据。该研究得到当地伦理委员会的批准。我们比较了机械通气患者反流事件和GRV的频率和幅度。在拔管前3小时和拔管后，当患者连接到HFNC时，都对这些参数进行了评估。患者作为自己的对照。为了评估拔管前和拔管后测量之间的差异，我们应用了参数配对t检验。
结果：包括10例患者（平均年龄58岁；平均APACHEII评分22；平均机械通气3.9天）。拔管前3小时，平均GRV为4.1ml/h，而HFNC为14.03ml/h（p=0.004）。通气患者的主要反流事件的平均频率为2.33/h，而HFNC患者为4.4/h（p=0.73）。通气患者的主要反流事件的平均频率为9.17/h，而HFNC患者为9.83/h（p=0.14）。
结论：利用smART+平台，我们证明，与机械通气患者相比，使用HFNC显着增加GRV，并可能增加主要反流事件的频率，从而增加了误吸的风险。需要进一步的研究来支持我们的结论。
