以系統性回顧比較經鼻高流量氧氣與傳統氧氣治療於急性呼吸衰竭病人之成效

A Systematic Review Comparing the Efficacy of Nasal High-flow Oxygen Therapy and Traditional Oxygen Therapy in Patients with Acute Respiratory Failure

"經鼻高流量氧氣治療利用持續性高流量氣 體，在吐氣期形成低正壓，如同持續性呼吸道正 壓（Continuous Positive Airway Pressure, CPAP）功 能，維持充足的氧合作用和肺泡通氣，運用於急性 呼吸衰竭病人，進而改善心肺功能；本文藉由完整 的文獻整理分析，歸納經鼻高流量氧氣治療於臨 床之運用。搜尋2010年1月至2020年3月間運用經 鼻高流量氧氣治療之隨機分派試驗文獻，進行系 統性文獻分析，資料庫包含Cochrane、PubMed、 CINAHL、ProQuest、華藝線上圖書館，以PICO 建立中、英文關鍵字，分別為P：急性呼吸衰竭 病人；I：經鼻高流量氧氣治療；C：傳統氧氣治 療；O：氧合濃度。共納入9篇文獻，以使用經鼻 高流量氧氣治療為介入措施，對於呼吸衰竭病人之 氧合狀態的改善及減少呼吸次數及置入氣管內管機 率有顯著差異。研究結果顯示對於急性呼吸衰竭病 人有助益，可降低氣管內管插管率及死亡率，改善 氧合狀態，未來應建立標準作業流程運用於臨床實 務中，如運用時機及方法、如何脫離等，未來仍應 繼續執行嚴謹、盲化、大規模的隨機控制試驗，以 驗證並更新此實證結果，以提供病人合宜的呼吸照 護。（澄清醫護管理雜誌 2021；17（3）：51-57）。"

In nasal high-flow oxygen therapy, continuous high-flow gas is used to form low positive pressure during exhalation. Just like the function of continuous positive airway pressure (CPAP), the therapy maintains adequate oxygenation and alveolar ventilation. It is applied to patients with acute respiratory failure, to improve heart and lung functions. This paper summarizes the clinical application of nasal high-flow oxygen therapy through complete literature analysis. Systematic analyses on randomized trials using nasal highflow oxygen therapy from January 2010 to March 2020 were searched and retrieved from the following databases: Cochrane, PubMed, CINAHL, ProQuest, and Airiti Library. The Chinese and English keywords were established by PICO: P: patients with acute respiratory failure; I: nasal high-flow oxygen therapy; C: traditional oxygen therapy; O: oxygenation concentration. A total of 9 articles were included. Nasal high-flow oxygen therapy as an intervention measure showed significant differences concerning the improvement of the oxygenation status, and the reduction of the respiratory frequency and probability of endotracheal intubation in patients with respiratory failure. The research results suggest that the therapy was beneficial for patients with acute respiratory failure; it could reduce the rates of endotracheal intubation and mortality, and improve oxygenation status. In the future, standard operating procedures should be established and applied in the clinical practice, concerning the timing and method of application, and the weaning from the therapy. In subsequent research, rigorous, blinded, and large-scale randomized controlled trials should be continued to verify and update these empirical results, to optimize the respiratory care approaches for patients in need. (Cheng Ching Medical Journal 2021; 17(3): 51-57)