比較高流量鼻導管和非侵襲性陽壓呼吸器對重插管率之影響－以台灣某北部醫學中心為例

Compare High Flow Nasal Cannula with Noninvasive Ventilation on Reintubation-in a Northern Taiwan Hospital

簡雅芳(Ya-Fang Chien) ； 丁秋碧(Chiu-Pi Ting) ； 賈德蓉(Te-Jung Chia) ； 龔昱中(Yu-Chung Kung)

《呼吸治療》 19卷1期 (2020/07) Pp. 1-11

https://doi.org/10.6269/JRT.202007_19(1).0001

摘要

研究背景：拔管失敗重插管會增加病人死亡率和增加住院花費，已有許多文獻表示於拔管後使用非侵襲性陽壓呼吸器（Noninvasive Positive Pressure Ventilation; NIPPV）可降低病人重插管率，但使用NIPPV有諸多缺點，而高流量鼻導管（High Flow Nasal Cannula; HFNC）能克服其缺點，且已有國外研究文獻表示拔管後使用HFNC或NIPPV的重插管率無差異，但相關文獻尚嫌不足且國內尚無相關研究文獻，因此本研究旨在比較拔管後使用HFNC或NIPPV的重插管率、住加護病房天數及死亡率等的臨床成效。研究方法：本研究為回溯性研究，收案自台灣北部某醫學中心加護病房於2015/01-2017/12期間，針對20歲以上成年人於拔管48小時內使用HFNC或NIPPV收案，統計並分析數據來比較HFNC或NIPPV臨床成效。結果：本研究收案總人數為164人，HFNC組57人，NIPPV組107人。HFNC組（24.6%）與NIPPV（17.8%）組重插管率無差異（p=0.301），HFNC組加護病房死亡率14%，NIPPV組5.6%，未達顯著差異（p=0.081）。HFNC組和NIPPV組加護病房住院天數的中位數皆為11天，HFNC組與NIPPV組總住院天數的中位數各為30天與25天，兩組未達顯著差異（p=0.187）。結論：拔管後使用HFNC對於重插管率、加護病房住院天數、死亡率及總住院天數等臨床結果，和使用NIPPV無顯著差異，但HFNC組的加護病房死亡率較高，雖未達統計上的顯著差異，但臨床人員應該密切注意病人拔管後使用HFNC情形，避免延遲插管。

關鍵字

高流量鼻導管 ； 非侵襲性陽壓呼吸器 ； 重插管率

並列摘要

BACKGROUND: Reintubation puts patient at risk of increased hospital cost and mortality rate. Studies have shown reduction in reintubation rate with the use of noninvasive positive pressure ventilation (NIPPV), however, this is accompanied by potential complications. According to literature, these side effects can be overcome using high flow nasal cannula (HFNC) with no significant difference in reintubation rate versus NIPPV. However, there are no such studies domestically, thus, the aim of our study was to evaluate the clinical outcomes of HFNC compared to NIPPV in post extubated patients. METHODS: We conducted a retrospective study in a single medical center ICU in northern Taiwan from January 2015 to December 2017. All patients were above 20 years old, with usage of NIPPV or HFNC within 48 hours after extubation. We collected and analyzed clinical data to understand the effect of NIPPV or HFNC to selected patients. RESULT: Of 164 patients, 57 received HFNC and 107 NIPPV. The rate of reintubation was not different between the HFNC group (24.6%) and NIPPV group (17.8%, p = 0.301). The ICU mortality rate in HFNC group is 14%, in NIPPV group is 5.6%. There was no significant difference between HFNC and NIPPV. The median stay in ICU is 11 days in HFNC and NIPPV. The median duration of hospital stay is 30 days in HFNC and 25 days in NIPPV. There was no significant difference between HFNC and NIPPV (p = 0.187). CONCLUSIONS: There is no significant difference between HFNC and NIPPV in reintubation rate, days in ICU, mortality rate, and hospital stays. There was a trend to increase ICU mortality rate in HFNC group compared to NIPPV. In an effort to delay reintubation, medical staff should pay greater attention to patients using HFNC after extubation.

並列關鍵字

high flow nasal cannula ； noninvasive positive pressure ventilation ； reintubation rate