結合ROX指數預測重插管高風險群之呼吸照護經驗

Respiratory Care Experience of Combining ROX index to Predict the High Risk of Re-intubation group: A Case Report

10.6269/JRT.202407_23(2).0003

趙大維(Ta-Wei Chao)；郭惟郁(Wei-Yu Kuo)；魏聖桓(Sheng-Huan Wei)；劉惠玲(Hui-Ling Liu)

ROX index ； 拔管後呼吸衰竭 ； 濕化高流量氧氣治療 ； ROX index ； Post-extubation respiratory failure ； High flow nasal oxygen therapy (HFNC)

呼吸治療

23卷2期（2024 / 07 / 01）

31 - 45

繁體中文;英文

拔管後呼吸衰竭及重插管會增加病人感染、住院天數、甚至死亡率。高流量氧氣系統（包含非侵襲性正壓呼吸器和濕化高流量氧氣治療）常被使用在高風險族群中。本個案為71歲男性因嚴重急性呼吸窘迫症候群而放置氣管內管給予機械通氣支持。考量其重插管高風險，拔管後給予非侵襲性正壓呼吸器但因病人與呼吸器呈現不同步而失敗，改用濕化高流量氧氣治療亦無改善，且ROX index下降，最終病人被重新插管。第二次拔管時再次使用濕化高流量氧氣治療，密切監測ROX index及臨床狀況，最終病人脫離呼吸器成功。因此在高風險拔管後呼吸衰竭病人，為了防止病人呼吸器脫離失敗，介入濕化高流量氧氣治療避免重新插管，並探討使用ROX index作為主要指標，輔以搭配P/F ratio、呼吸型態及生命徵象，監測病人需要再插管或使用NIPPV的時機。

Post-extubation respiratory failure and reintubation increase infection, hospital stay, and even mortality rates. The high-flow oxygen system, including the non-invasive positive pressure ventilation (NIPPV) and high flow nasal oxygen therapy (HFNC), is adjunctive oxygen therapy in high-risk patients. Herein, we present a case of a 71-year-old male who underwent mechanical ventilation for organizing pneumonia with acute respiratory distress syndrome (ARDS). Concerning his high risk of re-intubation, we tried NIPPV in his first extubation, which failed due to asynchrony. Alternatively, we applied HFNC, but deterioration of the respiratory condition with decreasing ROX index developed, and he was re-intubated. During the second time of extubation, we used HFNC again and monitored both the ROX index and the clinical condition closely. The patient was weaned off the ventilator successfully. The case emphasizes the vital role of high-flow oxygen system support for high-risk patients. Additionally, our experience of combining the ROX index as the major parameter, supplemented by the P/F ratio, respiratory pattern, and vital signs to evaluate post-extubation respiratory failure and determine the timing for re-intubation or NIPPV therapy.