Non-invasive ventilation in acute respiratory failure.
Non-invasive ventilation in acute respiratory failure.
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DOI：
10.1016/s0140-6736(09)60496-7
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发表时间：
2009-07-18
期刊：
影响因子：
--
通讯作者：
Hill N
中科院分区：
文献类型：
--
作者：
Nava S;Hill N
无创机械通气已越来越多地用于避免插管或作为插管的替代方案。与药物治疗相比，在某些情况下与有创机械通气相比，它提高了急性呼吸衰竭患者的生存率并减少了并发症。主要适应症为慢性阻塞性肺疾病加重、心源性肺水肿、免疫功能低下患者的肺浸润以及既往插管稳定的慢性阻塞性肺疾病患者的撤机。此外，该技术可用于术后患者或患有神经系统疾病的患者，以减轻晚期患者的症状，或帮助支气管镜检查;然而，在将其视为一线治疗之前，需要对这些情况进行进一步研究。应在重症监护室或高依赖性病房提供无创通气作为插管的替代方法。当用于防止插管在其他稳定的病人，它可以安全地管理在一个足够的人员配备和监测病房。
Non-invasive mechanical ventilation has been increasingly used to avoid or serve as an alternative to intubation. Compared with medical therapy, and in some instances with invasive mechanical ventilation, it improves survival and reduces complications in selected patients with acute respiratory failure. The main indications are exacerbation of chronic obstructive pulmonary disease, cardiogenic pulmonary oedema, pulmonary infiltrates in immunocompromised patients, and weaning of previously intubated stable patients with chronic obstructive pulmonary disease. Furthermore, this technique can be used in postoperative patients or those with neurological diseases, to palliate symptoms in terminally ill patients, or to help with bronchoscopy; however further studies are needed in these situations before it can be regarded as first-line treatment. Non-invasive ventilation implemented as an alternative to intubation should be provided in an intensive care or high-dependency unit. When used to prevent intubation in otherwise stable patients it can be safely administered in an adequately staffed and monitored ward.