Noninvasive pressure support ventilation in patients with acute respiratory failure. A randomized comparison with conventional therapy.
Noninvasive pressure support ventilation in patients with acute respiratory failure. A randomized comparison with conventional therapy.
复制标题
急性呼吸衰竭患者的无创压力支持通气。
作者：
M. Wysocki;L. Tric;M. Wolff;Henri Millet;B. Herman
在41例与慢性阻塞性肺疾病（COPD）无关的急性呼吸衰竭患者中，评估了无创压力支持通气（NIPSV）在避免气管插管和降低与气管插管相关的发病率和死亡率方面的益处。患者被随机分配接受常规治疗（n = 20）或常规治疗加NIPSV （n = 21）。NIPSV通过连接呼吸机（Puritan-Bennett 7200a）的口罩输送给患者，呼吸机设置为吸气压力支持（IPS）模式。平均IPS、呼气末正压（PEEP）和吸入氧分数（FIO2）分别为15 +/- 3cm H2O、4 +/- 2cm H2O和57 +/- 22%。气管插管率（62% vs 70%, p = 0.88）、ICU住院时间（17 +/- 19天vs 25 +/- 23天，p = 0.16）、死亡率（33 vs 50%, p = 0.46）两组间无显著差异。事后分析表明，在PaCO2浓度为45 mm Hg的患者中（n = 17）， NIPSV与气管插管率（36% vs 100%, p = 0.02）、ICU住院时间（13 +/- 15天vs 32 +/- 30天，p = 0.04）和死亡率（9 vs 66%, p = 0.06）相关。我们的结论是，系统地使用NIPSV治疗与COPD无关的所有形式的急性呼吸衰竭是没有益处的。以急性呼吸衰竭和高碳酸血症为特征的亚组患者可能从这种治疗中获益，需要进一步的研究来关注这方面。
The benefit of noninvasive pressure support ventilation (NIPSV) in avoiding the need for endotracheal intubation and reducing morbidity and mortality associated with endotracheal intubation was evaluated in 41 patients who presented with acute respiratory failure not related to chronic obstructive pulmonary disease (COPD). Patients were randomly assigned to receive conventional therapy (n = 20) or conventional therapy plus NIPSV (n = 21). NIPSV was delivered to the patient by a face mask connected to a ventilator (Puritan-Bennett 7200a) set in inspiratory pressure support (IPS) mode. The mean levels of IPS, positive end-expiratory pressure (PEEP), and fraction of inspired oxygen (FIO2) were respectively 15 +/- 3 cm H2O, 4 +/- 2 cm H2O, and 57 +/- 22%. The rate of endotracheal intubation (62 vs 70%, p = 0.88), the length of ICU stay (17 +/- 19 days vs 25 +/- 23 days, p = 0.16), and the mortality rate (33 vs 50%, p = 0.46) were not different between patients treated with NIPSV and those treated conventionally. Post hoc analysis suggested that in patients with PaCO2 > 45 mm Hg (n = 17), NIPSV was associated with a reduction in the rate of endotracheal intubation (36 vs 100%, p = 0.02), in the length of ICU stay (13 +/- 15 days vs 32 +/- 30 days, p = 0.04), and in the mortality rate (9 vs 66%, p = 0.06). We conclude that NIPSV is of no benefit when used systematically in all forms of acute respiratory failure not related to COPD. A subgroup of patients, characterized by acute ventilatory failure and hypercapnia, may potentially benefit from this therapy and further studies are needed to focus on this aspect.