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Oxygénothérapie humidifiée haut débit : quelles applications en réanimation ?

Recent applications for high flow nasal oxygen in the intensive care unit

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Médecine Intensive Réanimation

Résumé

L’oxygénothérapie à haut débit nasal (OHDN) est une technique de plus en plus utilisée en réanimation. Les travaux récents suggèrent que ses applications peuvent couvrir toutes les phases du séjour en réanimation d’un patient admis pour insuffisance respiratoire aiguë. Au cours de l’insuffisance respiratoire aiguë hypoxémique, l’OHDN a montré son efficacité dans la réduction de la mortalité en comparaison de son association à la ventilation non invasive ou de l’oxygénothérapie conventionnelle, avec des effets rapides sur la diminution des signes de détresse respiratoire et une meilleure tolérance que ces autres techniques. De même, chez les patients immunodéprimés, les données très récentes de la littérature médicale plaident pour l’utilisation de l’OHDN en première ligne. Il faut cependant prendre en compte les risques potentiellement liés à une intubation tardive et, comme pour la ventilation non invasive, adopter un algorithme prédéfini de recours à la ventilation invasive. L’OHDN est utilisée au cours des procédures à risque de désaturation, comme la préoxygénation avant intubation, bien que les données de la littérature médicale soient discordantes, ou le support au cours des endoscopies bronchiques avec lavage broncho-alvéolaire. Enfin, son utilité au décours de l’extubation des patients de réanimation est maintenant confirmée, en comparaison de la ventilation non invasive pour les patients les plus fragiles, ou de l’oxygénothérapie conventionnelle pour les patients à moindre risque.

Ainsi, on peut envisager l’utilisation de l’OHDN à chaque étape de la prise en charge du patient admis en réanimation pour une insuffisance respiratoire aiguë.

Abstract

High flow nasal cannula oxygen therapy (HFNC) is increasingly used in the intensive care unit (ICU). Recent data suggest that its use can encompass all stages of acute respiratory failure during patients’ ICU stay. During hypoxemic acute respiratory failure, HFNC has shown its efficacy in reducing mortality compared to its association with noninvasive ventilation or to conventional oxygen therapy alone. HFNC enabled a rapid decrease in respiratory distress signs, and an increased tolerance in comparison with these other techniques. Similarly, in immunocompromised patients, very recent data argues for the use of HFNC as a first step therapy. However, the risks of a potential delay in the intubation should be taken into account. As for non invasive ventilation, a predefined algorithm to switch towards invasive ventilation should be adopted. HFNC is used during procedures at risk for desaturation, such as preoxygenation before intubation, although published data are discordant, or to provide oxygen during fiber-optic bronchoscopy with bronchoalveolar lavage. Finally, its usefulness after extubation in ICU patients is now confirmed, compared to noninvasive ventilation for the most severe patients, or conventional oxygen therapy for patients less at-risk. Thus, one might now consider using HFNC for each step of the treatment of an acute respiratory failure patient in the ICU.

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Authors and Affiliations

  1. AP-HP, hôpital Louis Mourier, service de réanimation médicochirurgicale, 178 rue des Renouillers, F-92700, Colombes, France

    J. Messika, M. Laissi, M. Le Meur & J. -D. Ricard

  2. INSERM, IAME, UMR 1137, F-75018, Paris, France

    J. Messika & J. -D. Ricard

  3. Univ Paris Diderot, IAME, UMR 1137, Sorbonne Paris Cité, F-75018, Paris, France

    J. Messika & J. -D. Ricard

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  1. J. Messika
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  2. M. Laissi
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Messika, J., Laissi, M., Le Meur, M. et al. Oxygénothérapie humidifiée haut débit : quelles applications en réanimation ?. Méd. Intensive Réa 26, 31–39 (2017). https://doi.org/10.1007/s13546-016-1250-z

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  • DOI: https://doi.org/10.1007/s13546-016-1250-z

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