DrStéphanandcolleagues[]demonstrated,inalargemulticenternoninferiorityrandomizedtrial,thathigh-flownasaloxygencouldbeaseffectiveasnoninvasiveventilationinpreventingortreatingpostextubationacutehypoxemicrespiratoryfailureaftercardiothoracicsurgery.High-flownasaloxygenisanemergingoxygenationtechniquewithnumerousphysiologicalandclinicaladvantages[].However,someimportantissuesshouldbeaddressedbeforedrawingdefinitiveconclusionsfromthestudy.
在一项大样本多中心非劣效随机试验中，Stéphan医生及其同事发现[]，高流量鼻导管氧疗预防或治疗心胸外科手术拔管后急性低氧性呼吸功能衰竭与无创通气同样有效。高流量鼻导管氧疗是新出现的氧疗技术，具有很多生理及临床优点[]。然而，根据上述研究得到确切结论前，应当注意一些重要的问题。
Basedontheirinclusioncriteria,noninvasiveventilationorhigh-flownasaloxygenwasappliedaccordingtodifferentstrategies:()afterfailureofaspontaneousbreathingtrialasaweaningorextubationtechnique(earlyextubation);()afterasuccessfulspontaneousbreathingtrialinpatientsathigh-riskforpostextubationacuterespiratoryfailure(preventive);or()afterasuccessfulspontaneousbreathingtrialfollowedbyfailedextubation(curative)[].Resultsofthestudywerenotstratifiedorreportedaccordingtothesedifferentclinicalindications.
基于研究的入选标准，根据三种不同的策略实施无创通气或高流量氧疗：()自主呼吸试验（作为脱机或拔管技术）失败后（早期拔管）；()拔管后急性呼吸衰竭的高危患者自主呼吸试验成功后（预防性）；()自主呼吸试验成功但拔管失败（治疗性）[]。这一研究的结果并未根据上述不同临床适应症进行分层或报告。
Whenapplyingnoninvasiveventilationorotherrespiratorysupportduringthepostextubationperiod,thesituationsshouldbeclearlydistinguishedbytheclinicianbecausetheirrespectiveobjectivescanbedifferent.Toourknowledge,norandomizedclinicaltrialhasevaluatedastrategyofearlyextubationandnoninvasiveventilationinsurgicalpatientsfailingaspontaneousbreathingtrial.
拔管后使用无创通气或其他呼吸支持治疗措施时，临床医生需要早期识别上述三种情况，因为各自的治疗目的不同。据我们所知，尚无随机临床试验评价外科患者自主呼吸试验失败后早期拔管及无创通气的策略。
Inpostoperativepatients,studiesofpreventivepostextubationnoninvasiveventilationhaveproduceddiscordantresults[4].Bycontrast,morestudieshavebeenconductedofcurativepostextubationnoninvasiveventilation
