A 58-year-old man who is postoperative day one after a Whipple procedure develops increased shortness of breath. Oxygen saturation is 86% on 2-liter nasal cannula, respiratory rate is 32 breaths/min, and he is using accessory respiratory muscles. He is hemodynamically stable, alert, and oriented.
Which of the following interventions is most appropriate at this time?
A. Increase supplemental oxygen to keep oxygen saturation above 94%.
B. Start aggressive chest physical therapy.
C. Start noninvasive ventilation.
D. Start high-flow oxygen via nasal cannula.
答案解析：
腹部手术后，该患者存在重新插管的风险。血流动力学稳定，神志清楚。一项多中心前瞻性试验评价了腹部手术后有再插管风险的患者。再插管风险较高的患者被随机分配接受无创通气或辅助供氧。无创通气组需要重新插管的患者明显更少(33%vs. 45%)。在再插管风险较低的患者中，使用高流量鼻插管降低了再插管的风险(4.9%vs. 12.3%)。尚未研究高流量鼻插管与无创通气相比对高危患者的益处。但是，如果无创通气未改善呼吸衰竭或患者出现其他插管指征，如无法控制气道或血流动力学不稳定，则不延迟再插管非常重要。在这些情况下延迟插管会增加死亡率。
正确答案：C
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