OXIGENOTERAPIA NASAL DE ALTO FLUXO EM PACIENTES ADULTOS HOSPITALIZADOS: REVISÃO SISTEMÁTICA
DOI:
https://doi.org/10.63330/armv1n8-014Palavras-chave:
Oxigenoterapia, Insuficiência respiratória, Hospitalização, Unidades de Terapia IntensivaResumo
Introdução: A oxigenoterapia nasal de alto fluxo (ONAF) é uma modalidade de suporte respiratório não invasivo para insuficiência respiratória aguda (IRpA) em adultos hospitalizados, oferecendo vantagens fisiológicas sobre a oxigenoterapia convencional (OC) e a ventilação não invasiva (VNI). Objetivo: Esta revisão sistemática objetivou sintetizar a eficácia, segurança, benefícios fisiológicos e limitações da ONAF em diversos cenários clínicos. Métodos: Realizou-se uma busca sistemática nas bases de dados PubMed, Scopus e Cochrane Library, abrangendo artigos até junho de 2025, incluindo ensaios clínicos randomizados e estudos observacionais. Resultados: Foram incluídos 25 estudos. A ONAF demonstrou benefícios fisiológicos significativos, como lavagem do espaço morto, geração de PEEP e condicionamento do gás, e reduziu as taxas de intubação em pacientes com IRpA hipoxêmica e no período pós-extubação. Foi também bem tolerada e eficaz em ambientes perioperatórios e de emergência. Contudo, a evidência sobre a redução da mortalidade permanece limitada e inconsistente. Conclusão: ONAF é uma terapia eficaz e bem tolerada, diminuindo intubações em subgrupos específicos de pacientes. Seu impacto na mortalidade exige mais investigação, sendo crucial a seleção de pacientes e a implementação de protocolos padronizados para otimizar seu uso.
Referências
1. NISHIMURA, M. High-flow nasal cannula oxygen therapy in adults. Journal of Intensive Care, v. 3, 2015. DOI: 10.1186/s40560-015-0084-5.
2. PAPAZIAN, L. et al. Use of high-flow nasal cannula oxygenation in ICU adults: a narrative review. Intensive Care Medicine, v. 42, p. 1336-1349, 2016. DOI: 10.1007/s00134-016-4277-8.
3. SPOLETINI, G. et al. Heated Humidified High-Flow Nasal Oxygen in Adults: Mechanisms of Action and Clinical Implications. Chest, v. 148, n. 1, p. 253-261, 2015. DOI: 10.1378/chest.14-2871.
4. NISHIMURA, M. High-Flow Nasal Cannula Oxygen Therapy in Adults: Physiological Benefits, Indication, Clinical Benefits, and Adverse Effects. Respiratory Care, v. 61, n. 4, p. 529-541, 2016. DOI: 10.4187/respcare.04577.
5. CHUN, S. et al. The effect of high-flow nasal cannula on the work of breathing in patients with acute hypoxemic respiratory failure. Intensive Care Medicine, v. 43, n. 11, p. 1666-1673, 2017. DOI: 10.1007/s00134-017-4931-6.
6. QASEEM, A. et al. Appropriate Use of High-Flow Nasal Oxygen in Hospitalized Patients for Initial or Postextubation Management of Acute Respiratory Failure: A Clinical Guideline From the American College of Physicians. Annals of Internal Medicine, v. 174, n. 7, p. 977-984, 2021. DOI: 10.7326/M20-7533.
7. FRAT, J. P. et al. High-flow nasal oxygen in acute hypoxemic respiratory failure. New England Journal of Medicine, v. 372, n. 23, p. 2185-2196, 2015. DOI: 10.1056/NEJMoa1503326.
8. ROCHWERG, B. et al. High flow nasal cannula compared with conventional oxygen therapy for acute hypoxemic respiratory failure: a systematic review and meta-analysis. Intensive Care Medicine, v. 45, n. 5, p. 563-572, 2019. DOI: 10.1007/s00134-019-05590-5.
9. MARJANOVIC, N. et al. High-flow nasal cannula oxygen therapy in acute respiratory failure at Emergency Departments: A systematic review. The American Journal of Emergency Medicine, v. 38, n. 11, p. 2422-2428, 2020. DOI: 10.1016/j.ajem.2020.04.091.
10. MARJANOVIC, N. et al. High-flow nasal cannula oxygen versus noninvasive ventilation for the management of acute cardiogenic pulmonary edema: a randomized controlled pilot study. European Journal of Emergency Medicine, v. 31, n. 4, p. 267-275, 2024. DOI: 10.1097/MEJ.0000000000001128.
11. ANSARI, B. et al. A Randomized Controlled Trial of High-Flow Nasal Oxygen (Optiflow) as Part of an Enhanced Recovery Program After Lung Resection Surgery. The Annals of Thoracic Surgery, v. 101, n. 2, p. 459-464, 2016. DOI: 10.1016/j.athoracsur.2015.07.025.
12. SPENCE, E. et al. The Effectiveness of High-Flow Nasal Oxygen During the Intraoperative Period: A Systematic Review and Meta-analysis. Anesthesia & Analgesia, v. 131, n. 6, p. 1797-1808, 2020. DOI: 10.1213/ANE.0000000000005073.
13. WILSON, M. et al. High-Flow Nasal Cannula Oxygen in Patients with Acute Respiratory Failure and Do-Not-Intubate or Do-Not-Resuscitate Orders: A Systematic Review. Journal of Hospital Medicine, v. 14, n. 1, p. E1-E6, 2019. DOI: 10.12788/jhm.3329.
14. MATTHAY, M. A. et al. The Berlin definition of acute respiratory distress syndrome: should patients receiving high-flow nasal oxygen be included?. The Lancet Respiratory Medicine, v. 9, n. 8, p. 933-936, 2021. DOI: 10.1016/S2213-2600(21)00105-3.
15. LEMIALE, V. et al. High-Flow Nasal Cannula Oxygenation in Immunocompromised Patients With Acute Hypoxemic Respiratory Failure: A Groupe de Recherche Respiratoire en Réanimation Onco-Hématologique Study. Critical Care Medicine, v. 45, n. 8, p. e274–e280, 2017. DOI: 10.1097/CCM.0000000000002085.
16. HERNÁNDEZ, G. et al. Effect of High-Flow Nasal Cannula vs Conventional Oxygen Therapy on Reintubation and Postextubation Respiratory Failure in High-Risk Patients: A Randomized Clinical Trial. JAMA, v. 316, n. 15, p. 1565-1574, 2016. DOI: 10.1001/jama.2016.14194.
17. SJÖBLOM, A. Clinical and physiological consequences of preoxygenation using high‐flow nasal oxygen in emergency anaesthesia. Acta Anaesthesiologica Scandinavica, v. 68, 2024. DOI: 10.1111/aas.14499.
18. KIM, H. et al. Comparison of high-flow nasal oxygenation and standard low-flow nasal oxygenation during rigid bronchoscopy: a randomized controlled trial. Korean Journal of Anesthesiology, v. 78, n. 1, p. 39-47, 2024. DOI: 10.4097/kja.24517.
19. LIU, S. et al. Oxygen Therapy versus Non-Invasive Ventilation for AECOPD Patients After Extubation: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. International Journal of Chronic Obstructive Pulmonary Disease, v. 17, p. 1987-1999, 2022. DOI: 10.2147/COPD.S375107.
20. KOYAUCHI, T. et al. Efficacy and Tolerability of High-Flow Nasal Cannula Oxygen Therapy for Hypoxemic Respiratory Failure in Patients with Interstitial Lung Disease with Do-Not-Intubate Orders: A Retrospective Single-Center Study. Respiration, v. 96, n. 4, p. 323-329, 2018. DOI: 10.1159/000489890.
21. PIRRET, A. et al. Nasal high flow oxygen therapy in the ward setting: A prospective observational study. Intensive & Critical Care Nursing, v. 42, p. 127-134, 2017. DOI: 10.1016/j.iccn.2017.04.001.
22. JANSSEN, M. et al. Safety and Outcome of High-Flow Nasal Oxygen Therapy Outside ICU Setting in Hypoxemic Patients With COVID-19. Critical Care Medicine, v. 52, n. 1, p. 31-43, 2023. DOI: 10.1097/CCM.0000000000006068.
23. MELLADO-ARTIGAS, R. et al. High-flow nasal oxygen in patients with COVID-19-associated acute respiratory failure. Critical Care, v. 25, n. 1, p. 1-10, 2020. DOI: 10.1186/s13054-021-03469-w.
24. CORLEY, A. et al. High-flow nasal cannulae for respiratory support in adult intensive care patients. The Cochrane Database of Systematic Reviews, v. 5, n. 5, CD010172, 2017. DOI: 10.1002/14651858.CD010172.pub2.
25. RAMACHANDRAN, A. et al. Gastric Insufflation with High Flow Nasal Oxygen Therapy in Adult Patients Admitted to Intensive Care Unit: An Observational Study. Indian Journal of Critical Care Medicine: Peer-reviewed, Official Publication of Indian Society of Critical Care Medicine, v. 28, n. 4, p. 393-398, 2024. DOI: 10.5005/jp-journals-10071-24691.
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