高流量鼻導管對COVID-19重症病人之成效：系統性文獻回顧暨統合分析

Effectiveness of High-flow Nasal Cannula for Critically Ill Patients with COVID-19: A Systematic Literature Review and Meta-analysis

背景：高流量鼻導管於COVID-19期間成為非侵入性氧氣支持的重要選擇之一。目前已有多項研究探討高流量鼻導管於COVID-19重症病人的臨床成效，惟其在放置氣管內管率、死亡率、無使用呼吸器天數及入住加護病房天數等成效尚未獲得一致結論，仍需進一步探討。
目的：透過系統性文獻回顧暨統合分析，探討高流量鼻導管對COVID-19重症病人放置氣管內管率、死亡率、無使用呼吸器天數及入住加護病房天數之成效。
方法：依據PRISMA進行文獻篩選，搜尋MEDLINE、CINAHL、PubMed、CochraneLibrary、華藝線上圖書館資料庫，2020年4月至2025年4月。納入標準為研究設計為隨機對照試驗及具對照組之觀察性研究。文獻品質評估採用Jadad品質量表與紐卡索渥太華量表。統合分析使用Review Manager 5.4軟體進行隨機效應模型分析。
結果：本研究共納入24篇文獻。統合分析顯示，高流量鼻導管顯著降低COVID-19病人放置氣管內管率（p< .001），有助於降低死亡率（p= .02），但對於無使用呼吸器天數（p = .10）及入住加護病房天數（p= .21）則無顯著差異。
結論/實務應用：高流量鼻導管可有效降低COVID-19重症病人放置氣管內管率與死亡率，但對無使用呼吸器天數及入住加護病房天數之成效尚不明確。建議未來需進行更大規模隨機對照試驗，以確立高流量鼻導管在COVID-19重症病人的最佳成效。

Background: High-flow nasal cannula (HFNC) emerged as a vital non-invasive oxygen therapy during the COVID-19 pandemic. There is no consensus on its effectiveness in COVID-19 critically ill patients, especially in terms of intubation rates, mortality, ventilator-free days, and length of stay in the intensive care unit (ICU), which warrants further study.
Objective: To evaluate the effectiveness of HFNC in reducing intubation rates, mortality, ventilator-free days, and ICU length of stay among critically ill patients with COVID-19 through a systematic review and meta-analysis.
Methods: Following PRISMA guidelines, a comprehensive literature search was conducted in MEDLINE, CINAHL, PubMed, Cochrane Library, and Airiti Library for studies published between September 2019 and September 2024. Inclusion criteria comprised randomized controlled trials and observational studies with control groups. Study quality was assessed using the Jadad Scale and the Newcastle-Ottawa Scale. A random-effects model meta-analysis was conducted using Review Manager 5.4.
Results: Twenty-four studies met the inclusion criteria. The meta-analysis showed that HFNC significantly reduced intubation rates in patients with COVID-19 (p < .001) and was associated with a lower mortality (p = .02). However, no significant differences were observed in ventilator-free days (p = .10) or ICU length of stay (p = .21).
Conclusion / Implications for Practice: HFNC is effective in lowering intubation rates and mortality among critically ill patients with COVID-19. Its effects on ventilator-free days and ICU length of stay remain unclear. Further largescale randomized controlled trials are recommended to confirm its clinical effects in this population.