2019嚴重特殊傳染性肺炎（COVID-19）氧氣治療策略分享

The Experience Sharing of Oxygen Therapy Strategies on Coronavirus Disease (COVID-19)

何宗澤(Tsung-Tse Ho) ； 賈德蓉(Te-Jung Chia) ； 楊式興(Shih-Hsing, Yang)

《呼吸治療》 20卷1期 (2021/01) Pp. 73-80

https://doi.org/10.6269/JRT.202101_20(1).0009

摘要

撰文背景：2019嚴重特殊傳染性肺炎為2020年於全球大流行的新興傳染病，引起該疾病的新型冠狀病毒主要侵犯人體呼吸系統，若引發病人低血氧則需氧氣治療。由於新興傳染病尚無高證據等級的實證或臨床指引，故本文期盼透過匯整相關暫行指引及文獻，分享2019嚴重特殊傳染性肺炎的氧氣治療策略，提供臨床人員照護及流程制定參考，亦盼能拋磚引玉，使未來有更多分享與交流，以提升台灣國人的健康福祉。撰文方法與結果：本文為參考台灣疾病管制署及世界衛生組織暫行指引，結合相關文獻及臨床流程與經驗進行撰文分享。臨床建議應維持成人血氧飽和度大於90-92%，兒童視有無危急症狀應維持血氧飽和度大於90-94%。病人所處環境應備有血氧監測設備、氧氣供應系統、氧療用物等等。氧療用物選擇上應依病人血氧及臨床狀況使用，且避免使用會產生氣霧的用物（例如：霧化器）。若病況需高濃度氧氣或臨床狀況已迅速惡化時，應儘早插管。另外，現今暫行指引不建議常規使用經鼻高流量鼻導管，因其可能有潛在飛沫噴濺風險。若仍需使用，應加強注意相關人員感控防護措施，並且密切監測病人病況發展，以避免延遲插管造成預後不佳。結論：新型冠狀病毒感染病患進行氧氣治療時，應注意病人飛沫噴濺及避免氣霧產生，以利感染及環境控制。照護上應以病人為中心，適時調整氧氣用物，並於病情惡化時儘早插管。由於此為一新興傳染疾病，尚有許多未知領域待科學驗證，本文盼以呼吸治療學及相關文獻為基礎概念，供臨床照護及未來研究參考。

關鍵字

2019嚴重特殊傳染性肺炎 ； 新型冠狀病毒 ； 氧氣治療

並列摘要

Background: Coronavirus disease (COVID-19) is an emerging infectious disease which become global pandemic. The severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) that causes this disease mainly invades the human respiratory system. If it causes hypoxemia in patients, oxygen therapy is needed. As there is no high-level evidence or clinical guidance for this emerging infectious disease, this article looks forward to sharing the oxygen treatment strategies on COVID-19 by compiling relevant temporary guidelines and literature. Through this article, we can provide reference for clinical staff and process development. We also hope that everyone can initiate new ideas and make more sharing and exchanges in the future to improve the health and well-being of Taiwanese people. Methods and Outcomes: This article refers to the Taiwan Centers for Disease Control (Taiwan CDC) and the World Health Organization's interim guidelines, also include relevant literature and clinical procedures and experiences. Clinical recommendations should maintain SpO_2 ≥90-92% in adults, and children should maintain SpO_2 ≥90-94% depending on whether they have critical symptoms. The patient's environment should be equipped with pulse saturation monitoring equipment, oxygen supply system, oxygen therapy devices. The choice of oxygen therapy devices should be used according to the patient's pulse saturation and clinical conditions, and avoid the devices that generate aerosols (for example: nebulizer). If the condition requires a high concentration of oxygen or the clinical condition has rapidly deteriorated, intubation should be performed as soon as possible. In addition, current interim guidelines do not recommend the routine use of high flow nasal cannula because of the potential risk of droplet spray. If it still needs to be used, clinical staff should be paid more attention on the infection prevention and environment control, and the patient's condition development should be closely monitored to avoid the poor prognosis caused by delayed intubation. Conclusion: For infection and environmental control, during oxygen therapy, clinical staff should pay attention to the spray droplets from patients and avoid the generation of aerosol. The care should be patient-centered, adjust oxygen supplies in time, and intubate as soon as possible when the condition deteriorates. As this is an emerging infectious disease, there are still many unknown fields to be scientifically verified. This article hopes to use respiratory therapy and related studies as the basic concept for clinical care and future research.

並列關鍵字

coronavirus disease (COVID-19) ； severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ； oxygen therapy