非侵襲性正壓呼吸器和高流量氧氣鼻導管對新型冠狀病毒（COVID-19）病人之應用

Noninvasive positive pressure ventilator and high flow nasal cannula in coronavirus disease 2019(COVID-19) patients

李昆達(Kun-Ta Lee) ； 蘇千玲(Chien-Ling Su)

《呼吸治療》 20卷2期 (2021/07) Pp. 11-21

https://doi.org/10.6269/JRT.202107_20(2).0002

摘要

2019新型冠狀病毒疾病（Coronavirus Disease 2019, COVID-19）直至2021年1月全世界共有超過八千五百萬人確診，死亡人數超過一百八十萬人，屬於進展中的國際大流行呼吸道疾病。非侵襲性正壓通氣（Noninvasive Positive Pressure ventilation, NIPPV）及高流量氧氣鼻導管（High flow nasal cannula, HFNC）過往常用在呼吸衰竭病人之通氣支持上。因增加氣霧逸散，NIPPV及HFNC已被WHO（World Health Organization）及多國認定是氣霧產生程序（Aerosol Generating Procedure, AGP）的一環。然而臨床是否對醫療人員及周遭環境造成危害仍有待商榷。本文以2021年1月前文獻作探討，基於實證醫學的精神建立台灣在COVID-19個案使用於NIPPV或HFNC的呼吸治療臨床指引。若醫療人員未落實防護措施，NIPPV使用在過往呼吸道感染病人，將增加感染之風險。後續研究指出使用頭罩式面罩NIPPV（helmet NIPPV）可顯著降低氣霧逸散距離。雖然HFNC因流速提高而增加氣霧逸散距離，但可透過病人確實配戴外科口罩大幅降低。根據以上所述，基於保護重症資源及提早接受通氣支持避免疾病惡化，參考WHO及他國的準則，建議在維持負壓單一隔離病室，且照護人員穿戴完整個人防護設備下，進展到輕度急性呼吸窘迫症候群的COVID-19病人可能可以使用HFNC或NIV，而HFNC較適用於低血氧呼吸衰竭的病人；NIPPV適用於合併慢性阻塞性肺疾病及心因性肺水腫之高碳酸血症病人。

關鍵字

嚴重特殊傳染性肺炎 ； 非侵襲性呼吸器 ； 高流量氧氣鼻導管 ； 個人防護設備

並列摘要

As of January 2021, over 85 million people were diagnosed with Coronavirus Disease 2019 (COVID-19), a current pandemic of respiratory disease, and the death toll of it have surpassed 1.8 million. Non-Invasive Positive Pressure Ventilation (NIPPV) and High Flow Nasal Cannula (HFNC) are usually applied on patients of respiratory failure for ventilatory support, whether patients using NIPPV and HFNC would increase the aerosol dispersion and recognized as a part of aerosol generating procedure by World Health Organization (WHO) and several countries. However clinically, it causes harm to health professionals and their environment have not been confirmed. This review article is evidence-based and aimed at developing a guideline for caring patients with COVID-19 by using NIPPV and HFNC in Taiwan. For patients with other types of respiratory diseases, using NIPPV will significantly increase the risk of infection to healthcare workers if the protective measure is not fully implemented. Recently, several studies pointed out that wearing helmet mask connected to double-limb NPPV (helmet NIPPV) will decrease the distance of aerosol dispersion. As for the patients using HFNC, the distance of aerosol dispersion would increase with increased airflow, however, it would substantially decrease if surgical masks are worn properly. Based on the guidelines from WHO and other countries and the principle of critical care resources protection and early ventilator support for preventing deterioration, it is suggested that patients with mild acute respiratory distress syndrome (ARDS) caused by COVID-19 may receive NIPPV and HFNC in a negative-pressure isolation room with healthcare Workers properly wearing personal protective equipment. While NIPPV is suitable for patients with chronic obstructive pulmonary disease (COPD) and cardiogenic pulmonary edema combined with hypercapnia, HFNC is more suitable for patients with hypoxemic respiratory failure.

並列關鍵字

Coronavirus Disease-2019 (COVID-19) ； Noninvasive positive pressure ventilation (NIPPV) ； High flow nasal cannula (HFNC) ； Personal Protective Equipment (PPE)