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非侵襲性正壓通氣下不同吸氣正壓設定對加熱潮濕效能之影響

Heated humidification under various inspiratory airway pressure settings during non-invasive mechanical ventilation

摘要


當病人接受非侵襲性正壓通氣(non-invasive ventilation, NIV)治療時,為了達到適當通氣與氧合,必須接受高流量和高氣氧濃度之氣體,會增加呼吸道對吸入氣體溫度與濕度調節上的負擔。若濕度不足可能致使粘液黏稠堵塞呼吸道,導致氣道阻力增加。適當的增加NIV氣體濕度可以改善纖毛運動障礙。臨床人員常配合NIV使用加熱潮濕器(heated humidifier, HH),其加熱潮濕效能會因設定的吸氣正壓(inspiratory positive airway pressure, IPAP)與流量所影響,因此,本研究的目的是評估NIV使用時,不同IPAP設定下的氣體加熱潮濕變化,並檢驗自動調節式HH是否能隨不同治療IPAP設定而調節其加熱潮濕效能。以實驗室模擬測試NIV三種IPAP壓力設定下,氣流經由刻度式HH(設定1-9)或自動調節式HH(NIV 模式),監測氣體輸送至呼吸道的溫度、絕對濕度(absolute humidity, AH)及相對濕度(relative humidity, RH)變化。結果顯示刻度式HH,在相同刻度設定時,設定IPAP越高傳送氣體溫度越高,但刻度大於「7」時,趨於穩定30℃,不會因設定IPAP增加而使氣體溫度增加。相同IPAP設定下,氣體溫度隨者刻度調升而上升,但到了刻度7-9之設定,溫度則無顯著差異,且壓力設定會影響AH(p<0.001)。自動調節式HH在不同IPAP壓力時溫度可維持31-32℃,但RH及AH會隨著壓力調升而下降(p<0.001)。本研究結果建議將刻度式HH刻度調整並維持在「刻度7」以上以維持溫濕度穩定;而自動調節式HH,其功能可以維持溫度穩定但AH會隨之下降,臨床人員應注意因濕度下降所產生之生理變化。

並列摘要


The airway humidification regulatory mechanism to incoming gas from nose to alveoli may be inadequate when a patient receives non-invasive ventilation (NIV) with high flow and high inspired oxygen concentration, which increasing the loads of upper airways functions on heating and humidifying the inspired gas. Appropriate humidity therapy during NIV prevents impaired mucociliary action and mucous plugs, resulting in increased airway resistance. Clinicians cooperate a heated humidifier (HH) during NIV, yet the inspiratory positive airway pressure (IPAP) and flow settings influence the effectiveness of an HH. Therefore, the present study aimed to evaluate humidification changes and the performance of an automatic HH under different pressure during NIV therapy. We conducted a bench model testing a dialed HH and an automatic HH with three IPAP settings. Temperature, absolute humidity (AH), and relative humidity (RH) were recorded at the distal of the airway. Results illustrated that, with the same dial setting, the higher the IPAP set, the higher the temperature was delivered, and it was stabilized at 30℃ at the dial 7. With same IPAP setting, gas temperature significantly increased with each increment till dial 7, and the IPAP impacts the AH. The automatic HH maintained the temperature at 31-32℃, and the RH and AH decreased along with increased the IPAP (p <0.001). In conclusion, to sustain stable humidification, we suggest set the dialed HH at number 7-9. The automatic HH provides stable temperature, but the AH reduces when pressure increases. The clinical impact of reduced humidification should be causally evaluated.

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