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系統識別號 U0026-2108201911143700
論文名稱(中文) 使用高流量鼻導管治療急性呼吸衰竭之效果
論文名稱(英文) High flow nasal cannula to treat the acute respiratory failure
校院名稱 成功大學
系所名稱(中) 公共衛生研究所碩士在職專班
系所名稱(英) Graduate Institute of Public Health(on the job class)
學年度 107
學期 2
出版年 108
研究生(中文) 羅蓓怡
研究生(英文) Pei-Yi Lo
電子信箱 beibeilo0111@gmail.com
學號 SB7061065
學位類別 碩士
語文別 中文
論文頁數 52頁
口試委員 指導教授-王榮德
指導教授-林聖翔
口試委員-陳欽明
口試委員-陳昌文
中文關鍵字 高流量鼻導管  支持向量機  預測因子 
英文關鍵字 High flow nasal cannula failure  SVM  predictors 
學科別分類
中文摘要 研究背景
近年來高流量鼻導管是臨床醫師治療急性呼吸衰竭症狀使用的首選設備,這是一項非侵襲性的氧氣供應設備,可提供100%加濕加熱氣體,最高可設定氣流為60升/分鐘,其應用的目的在於改善臨床症狀、避免插管,以及降低插管相關併發症的產生機率,在過去研究也表示對於缺氧性急性呼吸衰竭患者此設備是安全且有效的,儘管此設備有許多優點,但其效果較為有限,仍有許多患者使用後無法改善臨床症狀,進而需接受侵襲性呼吸器輔助治療,因而衍生延遲插管及過度濫用等相關問題,若是不恰當的使用可能造成健保資源的浪費,因此評估高流量鼻導管使用之成效,以及治療失敗之預測因子具有一定的重要性。
研究目的
探討高流量鼻導管應用於重症單位急性呼吸衰竭患者使用成效及治療失敗之預測因子。
材料與方法
本研究為回溯型世代研究,將以南部某醫學中心為例,利用醫學中心臨床資料之特性,蒐集2017年6月13日至2018年12月31日間於重症加護單位,因急性呼吸衰竭使用高流量鼻導管治療之患者之臨床資料,使用邏輯斯迴歸分析探討高流量鼻導管治療患者影響治療成效的重要因子,所有個案來自於10位加護病房主治醫師的判斷及治療,為避免相依性問題,以廣義估計方程式再次進行迴歸分析,此外,以支援向量機模型建構預測模型及評估其預測力。
結果與討論
本文共收集189位患者,其中99位治療失敗(53.4%),需進一步使用呼吸器輔助。研究結果顯示治療失敗組住院死亡率、加護病房住院天數,以及總住院天數皆顯著高於治療成功組;此外,多變量分析結果顯示P/F ratio與APACHE II 為高流量鼻導管治療失敗較重要之因子,經廣義估計方程式再次行迴歸分析,結果與邏輯斯迴歸結果差異不大,表示個案間相依性低;以支援向量機建構預測模型,疾病嚴重度與氧合指數 (APACHE II + P/F ratio)用於預測治療失敗準確率較高,準確率為72.1%,敏感度88.2%,特異度53.7%。
結論
在台灣地區,高流量鼻導管使用之成效對照國外研究結果相似。疾病嚴重度(APACHE II)與氧合指數(PaO2/FiO2)為評估高流量鼻導管治療失敗較重要的指標,可能可作為評估適用性的預測因子。
英文摘要 Purpose: To evaluate the predictors of high flow nasal cannula (HFNC) failure in intensive care unit (ICU) patients with acute respiratory failure (ARF). Methods: The patients are collected from a medical center in Taiwan between June 13, 2017, and December 31, 2018. One hundred eighty-nine subjects were divided into a HFNC success group (48%) and a HFNC failure group (52%). The clinical characteristics and physiologic effects before HFNC used were retrospectively reviewed and compared between the groups. Results: The study outcome of hospital mortality, ICU length, and hospital length were significantly higher in the HFNC failure group than in the HFNC success group. The results of the multivariate analysis indicated that APACHE II and PaO2/FiO2 were significantly different between groups. The support vector machine (SVM) classifier model shows that APACHE II + PaO2/FiO2 gives the highest accuracy of 72.1% to predict HFNC failure. Conclusion: The baseline APACHE II and PaO2/FiO2 were independently associated with HFNC failure.
Key words: High flow nasal cannula failure, SVM, predictors
論文目次 中文摘要 I
Extended Abstract III
致謝 VI
目錄 VIII
表目錄 X
圖目錄 X
第一章 前言 1
1.1研究背景 1
1.2研究假說 2
1.3研究目的 2
第二章 文獻回顧 3
2.1 高流量鼻導管簡介 3
2.1.1高流量鼻導管之生理特性 3
2.1.2高流量鼻導管與一般氧氣治療設備之比較 4
2.1.3高流量鼻導管與非侵襲性正壓呼吸器 5
2.1.4高流量鼻導管之臨床應用 5
2.2急性呼吸衰竭 7
2.2.1氧氣對急性呼吸衰竭之重要性 8
2.2.2 高流量鼻導管於急性呼吸衰竭之應用 8
第三章 研究材料與方法 10
3.1研究問題 10
3.2研究資料來源 10
3.3研究設計 10
3.3.1高流量鼻導管設備 11
3.3.2收案條件 12
3.3.3排除條件 12
3.3.4操作型定義 13
3.3.5 研究流程 13
3.4研究工具 14
3.4.1人口學特性 14
3.4.2疾病特性 14
3.5資料分析 17
3.5.1描述性統計 17
3.5.2 分析性統計 17
3.6 研究對象之保護措施 18
第四章 研究結果 19
4.1使用高流量鼻導管前研究個案臨床特性之差異分析 19
4.2高流量鼻導管應用於重症單位急性呼吸衰竭患者使用之成效 24
4.3影響高流量鼻導管治療失敗之預測因子-邏輯斯迴歸 25
4.4不同醫師評估病人之相依性問題-廣義估計方程式 31
4.5高流量鼻導管治療失敗的預測因子之預測模型-支持向量機模型 35
第五章 討論 37
5.1高流量鼻導管應用於重症單位急性呼吸衰竭患者使用之成效 37
5.2高流量鼻導管應用於急性呼吸衰竭治療失敗之預測因子探討 40
5.3研究限制 44
5.4臨床應用 45
第六章 結論與建議 46
第七章 參考文獻 48
附錄一 52
參考文獻 1. Sztrymf B, Messika J, Bertrand F, et al. Beneficial effects of humidified high flow nasal oxygen in critical care patients: a prospective pilot study. Intensive Care Med. 2011;37:1780.
2. Lenglet H, Sztrymf B, Leroy C, Brun P, Dreyfuss D, Ricard J-D. Humidified high flow nasal oxygen during respiratory failure in the emergency department: feasibility and efficacy. Respir Care. 2012;57:1873-78.
3. Moretti M, Cilione C, Tampieri A, Fracchia C, Marchioni A, Nava S. Incidence and causes of non-invasive mechanical ventilation failure after initial success. Thorax. 2000;55:819-25.
4. Roca O, Riera J, Torres F, Masclans JR. High-flow oxygen therapy in acute respiratory failure. Respir Care. 2010;55:408-13.
5. Tiruvoipati R, Lewis D, Haji K, Botha J. High-flow nasal oxygen vs high-flow face mask: a randomized crossover trial in extubated patients. J Crit Care. 2010;25:463-68.
6. Rittayamai N, Tscheikuna J, Rujiwit P. High-flow nasal cannula versus conventional oxygen therapy after endotracheal extubation: a randomized crossover physiologic study. Respir Care. 2014;59:485-90.
7. Kang BJ, Koh Y, Lim C-M, et al. Failure of high-flow nasal cannula therapy may delay intubation and increase mortality. Intensive Care Med. 2015;41:623-32.
8. Parke R, McGuinness S, Eccleston M. Nasal high-flow therapy delivers low level positive airway pressure. Br J Anaesth. 2009;103:886-90.
9. Corley A, Caruana LR, Barnett AG, Tronstad O, Fraser JF. Oxygen delivery through high-flow nasal cannulae increase end-expiratory lung volume and reduce respiratory rate in post-cardiac surgical patients. Br J Anaesth. 2011;107:998-1004.
10. Chatila W, Nugent T, Vance G, Gaughan J, Criner GJ. The effects of high-flow vs low-flow oxygen on exercise in advanced obstructive airways disease. Chest. 2004;126:1108-15.
11. Mündel T, Feng S, Tatkov S, Schneider H. Mechanisms of nasal high flow on ventilation during wakefulness and sleep. J Appl Physiol. 2013;114:1058-65.
12. Dysart K, Miller TL, Wolfson MR, Shaffer TH. Research in high flow therapy: mechanisms of action. Respir Med. 2009;103:1400-05.
13. Chanques G, Riboulet F, Molinari N, et al. Comparison of three high flow oxygen therapy delivery devices: a clinical physiological cross-over study. Minerva Anestesiol. 2013;79:1344-55.
14. Parke RL, Eccleston ML, McGuinness SP. The effects of flow on airway pressure during nasal high-flow oxygen therapy. Respir Care. 2011;56:1151-55.
15. Vargas F, Saint-Leger M, Boyer A, Bui NH, Hilbert G. Physiologic effects of high-flow nasal cannula oxygen in critical care subjects. Respir Care. 2015:respcare. 03814.
16. Roca O, Hernandez G, Diaz-Lobato S, Carratala JM, Gutierrez RM, Masclans JR. Current evidence for the effectiveness of heated and humidified high flow nasal cannula supportive therapy in adult patients with respiratory failure. Crit Care. 2016;20:109.
17. Groves N, Tobin A. High flow nasal oxygen generates positive airway pressure in adult volunteers. Aust Crit Care. 2007;20:126-31.
18. Hernández G, Roca O, Colinas L. High-flow nasal cannula support therapy: new insights and improving performance. Critical Care. 2017;21:62.
19. Sztrymf B, Messika J, Mayot T, Lenglet H, Dreyfuss D, Ricard J-D. Impact of high-flow nasal cannula oxygen therapy on intensive care unit patients with acute respiratory failure: a prospective observational study. J Crit Care. 2012;27:324. e9-24. e13.
20. Cuquemelle E, Pham T, Papon J-F, Louis B, Danin P-E, Brochard L. Heated and humidified high-flow oxygen therapy reduces discomfort during hypoxemic respiratory failure. Respir Care. 2012;57:1571-77.
21. Vital FM, Ladeira MT, Atallah ÁN. Non‐invasive positive pressure ventilation (CPAP or bilevel NPPV) for cardiogenic pulmonary oedema. The Cochrane Library. 2013.
22. Ram FS, Picot J, Lightowler J, Wedzicha JA. Non‐invasive positive pressure ventilation for treatment of respiratory failure due to exacerbations of chronic obstructive pulmonary disease. The Cochrane Library. 2004.
23. Burns K, Adhikari N, Keenan SP, Meade MO. Noninvasive positive pressure ventilation as a weaning strategy for intubated adults with respiratory failure. Cochrane Database Syst Rev. 2010;8.
24. Wilkinson D, Andersen C, O’Donnell CP, De Paoli AG. High flow nasal cannula for respiratory support in preterm infants. Cochrane Database Syst Rev. 2011;5.
25. Miguel-Montanes R, Hajage D, Messika J, et al. Use of high-flow nasal cannula oxygen therapy to prevent desaturation during tracheal intubation of intensive care patients with mild-to-moderate hypoxemia. Crit Care Med. 2015;43:574-83.
26. Maggiore SM, Idone FA, Vaschetto R, et al. Nasal high-flow versus Venturi mask oxygen therapy after extubation. Effects on oxygenation, comfort, and clinical outcome. Am J Respir Crit Care Med. 2014;190:282-88.
27. Corley A, Bull T, Spooner AJ, Barnett AG, Fraser JF. Direct extubation onto high-flow nasal cannulae post-cardiac surgery versus standard treatment in patients with a BMI≥ 30: a randomised controlled trial. Intensive Care Med. 2015;41:887-94.
28. Fan E, Del Sorbo L, Goligher EC, et al. An official American Thoracic Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine clinical practice guideline: mechanical ventilation in adult patients with acute respiratory distress syndrome. Am J Respir Crit Care Med. 2017;195:1253-63.
29. Mercat A, Richard J-CM, Vielle B, et al. Positive end-expiratory pressure setting in adults with acute lung injury and acute respiratory distress syndrome: a randomized controlled trial. JAMA. 2008;299:646-55.
30. Meade MO, Cook DJ, Guyatt GH, et al. Ventilation strategy using low tidal volumes, recruitment maneuvers, and high positive end-expiratory pressure for acute lung injury and acute respiratory distress syndrome: a randomized controlled trial. JAMA. 2008;299:637-45.
31. Force ADT, Ranieri V, Rubenfeld G. Acute respiratory distress syndrome. JAMA. 2012;307:2526-33.
32. Kallstrom TJ. AARC Clinical Practice Guideline: oxygen therapy for adults in the acute care facility--2002 revision & update. Respir Care. 2002;47:717-20.
33. Frat J-P, Thille AW, Mercat A, et al. High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure. N Engl J Med. 2015;372:2185-96.
34. Leeies M, Flynn E, Turgeon AF, et al. High-flow oxygen via nasal cannulae in patients with acute hypoxemic respiratory failure: a systematic review and meta-analysis. Syst Rev. 2017;6.
35. Messika J, Ben Ahmed K, Gaudry S, et al. Use of High-Flow Nasal Cannula Oxygen Therapy in Subjects With ARDS: A 1-Year Observational Study. Respir Care. 2014.
36. Esteban A, Frutos F, Tobin MJ, et al. A comparison of four methods of weaning patients from mechanical ventilation. N Engl J Med. 1995;332:345-50.
37. Boles J-M, Bion J, Connors A, et al. Weaning from mechanical ventilation. Eur Respir J. 2007;29:1033-56.
38. Seymour CW, Martinez A, Christie JD, Fuchs BD. The outcome of extubation failure in a community hospital intensive care unit: a cohort study. Critical Care. 2004;8:R322.
39. Sinnige J, Braspenning J, Schellevis F, Stirbu-Wagner I, Westert G, Korevaar J. The prevalence of disease clusters in older adults with multiple chronic diseases–a systematic literature review. PLoS One. 2013;8:e79641.
40. Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315:801-10.
41. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13:818-29.
42. Kim W-Y, Sung H, Hong S-B, Lim C-M, Koh Y, Huh JW. Predictors of high flow nasal cannula failure in immunocompromised patients with acute respiratory failure due to non-HIV pneumocystis pneumonia. J Thorac Dis. 2017;9:3013.
43. Lemiale V, Mokart D, Mayaux J, et al. The effects of a 2-h trial of high-flow oxygen by nasal cannula versus Venturi mask in immunocompromised patients with hypoxemic acute respiratory failure: a multicenter randomized trial. Critical Care. 2015;19:380.
44. Frat J-P, Ragot S, Girault C, et al. Effect of non-invasive oxygenation strategies in immunocompromised patients with severe acute respiratory failure: a post-hoc analysis of a randomised trial. The Lancet Respiratory Medicine. 2016;4:646-52.
45. Lemiale V, Resche-Rigon M, Mokart D, et al. High-flow nasal cannula oxygenation in immunocompromised patients with acute hypoxemic respiratory failure: a groupe de recherche respiratoire en réanimation onco-hématologique study. Crit Care Med. 2017;45:e274-e80.
46. Azoulay E, Lemiale V, Mokart D, et al. Effect of high-flow nasal oxygen vs standard oxygen on 28-day mortality in immunocompromised patients with acute respiratory failure: the HIGH randomized clinical trial. JAMA. 2018;320:2099-107.
47. Roca O, Messika J, Caralt B, et al. Predicting success of high-flow nasal cannula in pneumonia patients with hypoxemic respiratory failure: The utility of the ROX index. J Crit Care. 2016;35:200-05.
48. Alladi SM, Shinde Santosh P, Ravi V, Murthy US. Colon cancer prediction with genetic profiles using intelligent techniques. Bioinformation. 2008;3:130.

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