BACKGROUND Experimental and pilot clinical data suggest that spontaneously breathing patients with sepsis and septic shock may present increased respiratory drive and effort, even in the absence of pulmonary infection. The study hypothesis was that respiratory drive and effort may be increased in septic patients and correlated with extrapulmonary determinant and that high-flow nasal cannula may modulate drive and effort. METHODS Twenty-five nonintubated patients with extrapulmonary sepsis or septic shock were enrolled. Each patient underwent three consecutive steps: low-flow oxygen at baseline, high-flow nasal cannula, and then low-flow oxygen again. Arterial blood gases, esophageal pressure, and electrical impedance tomography data were recorded toward the end of each step. Respiratory effort was measured as the negative swing of esophageal pressure (ΔPes); drive was quantified as the change in esophageal pressure during the first 500 ms from start of inspiration (P0.5). Dynamic lung compliance was calculated as the tidal volume measured by electrical impedance tomography, divided by ΔPes. The results are presented as medians [25th to 75th percentile]. RESULTS Thirteen patients (52%) were in septic shock. The Sequential Organ Failure Assessment score was 5 [4 to 9]. During low-flow oxygen at baseline, respiratory drive and effort were elevated and significantly correlated with arterial lactate (r = 0.46, P = 0.034) and inversely with dynamic lung compliance (r = -0.735, P < 0.001). Noninvasive support by high-flow nasal cannula induced a significant decrease of respiratory drive (P0.5: 6.0 [4.4 to 9.0] vs. 4.3 [3.5 to 6.6] vs. 6.6 [4.9 to 10.7] cm H2O, P < 0.001) and effort (ΔPes: 8.0 [6.0 to 11.5] vs. 5.5 [4.5 to 8.0] vs. 7.5 [6.0 to 12.6] cm H2O, P < 0.001). Oxygenation and arterial carbon dioxide levels remained stable during all study phases. CONCLUSIONS Patients with sepsis and septic shock of extrapulmonary origin present elevated respiratory drive and effort, which can be effectively reduced by high-flow nasal cannula. EDITOR’S PERSPECTIVE

中文翻译：

---

败血症和败血性休克患者的呼吸驱动：高流量鼻插管的调节。

背景实验和试点临床数据表明，即使没有肺部感染，脓毒症和感染性休克的自主呼吸患者也可能表现出呼吸动力和努力增加。该研究假设脓毒症患者的呼吸动力和努力可能会增加，并与肺外决定因素相关，并且高流量鼻插管可能会调节动力和努力。方法 纳入 25 名患有肺外脓毒症或感染性休克的非插管患者。每个患者都经历了三个连续步骤：基线低流量吸氧、高流量鼻插管、然后再次低流量吸氧。在每个步骤结束时记录动脉血气、食道压力和电阻抗断层扫描数据。呼吸努力被测量为食管压力的负摆幅（ΔPes）；驱动力被量化为吸气开始后前 500 毫秒内食管压力的变化 (P0.5)。动态肺顺应性计算为电阻抗断层扫描测量的潮气量除以 ΔPes。结果以中位数表示[第 25 至第 75 个百分位数]。结果 13 名患者（52%）出现感染性休克。序贯器官衰竭评估评分为 5 [4 至 9]。在基线低流量吸氧期间，呼吸动力和努力程度升高，并与动脉乳酸显着相关（r = 0.46，P = 0.034），与动态肺顺应性成反比（r = -0.735，P < 0.001）。高流量鼻插管的无创支持导致呼吸动力显着降低（P0.5：6.0 [4.4 至 9.0] vs. 4. 3 [3.5 至 6.6] 对比 6.6 [4.9 至 10.7] cm H2O，P < 0.001）和努力（ΔPes：8.0 [6.0 至 11.5] 对比 5.5 [4.5 至 8.0] 对比 7.5 [6.0 至 12.6] cm H2O ，P < 0.001）。在所有研究阶段，氧合和动脉二氧化碳水平保持稳定。结论肺外源性脓毒症和感染性休克患者的呼吸动力和努力程度升高，可通过高流量鼻插管有效降低。编辑的观点 高流量鼻导管可有效减少。编辑的观点 高流量鼻导管可有效减少。编辑的观点