加熱潮濕高流量氧氣T型管於呼吸器脫離的自發性呼吸測試之成效

The effect of heated and humidified high-flow T-piece oxygen in spontaneous breathing trial during weaning from mechanical ventilation

許筱涵(Hsiao-Han Hsu) ； 孫偉柏(Wei-Po Sun) ； 謝國洲(Kou-Chou Hsieh) ； 熊得志(Te-Chih Hsiung) ； 楊式興(Shin-Shing Yang) ； 吳清平(Chin-Pyng Wu)

《呼吸治療》 22卷1期 (2023/01) Pp. 15-27

https://doi.org/10.6269/JRT.202301_22(1).0002

摘要

前言：自發性呼吸測試（spontaneous breathing trial, SBT）在實證醫學研究提到能預測呼吸器脫離成功；加熱潮濕高流量氧氣T型管（heated and humidified high-flow T-piece oxygen, HHHFTP）治療，也已被證實可以增進病人氧合與舒適度。SBT大都使用傳統T型管（T-piece, TP）來進行，是否可以導入HHHFTP於SBT？研究方法：前瞻性隨機研究，於2014年12月至2016年12月，在聯新國際醫院綜合加護病房進行，年齡大於18歲急性呼吸衰竭病人，使用呼吸器大於24小時，進行1小時SBT，若當日通過SBT定義為SBT成功，由主治醫師移除氣管內管。研究結果：實驗組HHHFTP有61位；對照組TP組有66位，兩組在SBT成功所需天數，HHHFTP組為1.3±0.7天，TP組為1.5±1.2天，無顯著差異（P=0.079）。平均使用呼吸器天數，HHHFTP組為6.2±4.3天，TP組為6.1±3.7天，無顯著差異（P=0.198）。平均加護病房（intensive care unit, ICU）住院天數，HHHFTP組是8.7±5天，TP組是8.8±5.1天，無顯著差異（P=0.372）。兩組的呼吸器脫離率皆為100%。結論與建議：病人進行SBT是預測成功拔管的方式之一，此研究比較新的HHHFTP與傳統TP方式進行SBT，發現在SBT通過天數，平均呼吸器天數，平均ICU住院天數、呼吸器脫離成功率都無顯著差異，所以建議HHHFTP可以使用於SBT中，因為HHHFTP有加熱濕度，高流量穩定的氧氣濃度，可能可以增進病人在SBT時的舒適度。

關鍵字

呼吸器脫離 ； 自發性呼吸測試 ； 加熱潮濕高流量氧氣T型管 ； T型管 ； 拔管

並列摘要

Introduction: Spontaneous breathing trial (SBT) has been reported in evidenced-based medical studies to predict the success of ventilator weaning; Heated and humidified high-flow T-piece oxygen (HHHFTP) treatment, has also been shown to improve patient oxygenation and comfort. The SBT is most performed using a traditional T-piece (TP), whether HHHFTP can be used for SBT? Purpose: To compare the effectiveness of SBT with HHHFTP and TP. Methods: Prospective randomized study, conducted in the general intensive care unit of Landseed International Hospital from December 31, 2014, to December 31, 2016, patients with acute respiratory failure aged over 18 years, using a ventilator for more than 24 hours, the 1 hour of SBT, SBT successful was defined as SBT pass on the same day, and then the endotracheal tube was extubated by the attending physician. Results: There were 61 HHHFTP in the experimental group and 66 in the TP group in the control group. The number of days required for the two groups to succeed in SBT was 1.3±0.7 days in the HHHFTP group and 1.5±1.2 days in the TP group, and there was no significant difference between the two groups (P =0.079). The average ventilator days were 6.2±4.3 days in the HHHFTP group and 6.1±3.7 days in the TP group, with no significant difference between the two groups (P = 0.198). The mean length of stay in the intensive care unit (ICU) was 8.7±5 days in the HHHFTP group and 8.8±5.1 days in the TP group, with no significant difference between the two groups (P = 0.372). The ventilator weaning rate was 100% in both groups. Conclusions and suggestions: The SBT is one of the most important ways to predict extubating success in patients with weaning from mechanical ventilation. The present study compared the new HHHFTP with traditional TP for SBT and found that the number of days in SBT passed, the average ventilator days, and the average ICU days. There was no significant difference in ICU days and the success weaning rate of the ventilator, so it is suggested that HHHFTP can be used in SBT because HHHFTP has heating humidity, high flow, and stable oxygen concentration, which may improve the comfort of patients during SBT.

並列關鍵字

ventilator weaning ； spontaneous breathing test ； heated high-flow oxygen T-tube ； T-tube ； extubation