International Consensus Conferences in Intensive Care Medicine: non-invasive positive pressure ventilation in acute respiratory failure. Organised jointly by the American Thoracic Society, the European Respiratory Society, the European Society of Intensive Care Medicine, and the Societe de Reanimation de Langue Francaise, and approved by the ATS Board of Directors, December 2000.
International Consensus Conferences in Intensive Care Medicine: non-invasive positive pressure ventilation in acute respiratory failure. Organised jointly by the American Thoracic Society, the European Respiratory Society, the European Society of Intensive Care Medicine, and the Societe de Reanimation de Langue Francaise, and approved by the ATS Board of Directors, December 2000.
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DOI：
10.1007/s001340000721
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发表时间：
2001-01-01
影响因子：
38.9
通讯作者：
Evans, T W
中科院分区：
文献类型：
--
作者：
Evans, T W
患者需要呼吸辅助以降低PaCO 2（图1）和/或改善氧合（图2）。如果他们能得到适当的非侵入性的辅助治疗，患者就可以避免与ETI相关的不适和风险。虽然研究表明NPPV与医院获得性肺炎的发生率降低有关，但方法学问题要求重新调查这一问题。潜在受益必须与鼻罩或面罩的不适和NPPV特有的风险（例如，无法提供足够的氧合或CO2消除、眼或鼻创伤、胃扩张/误吸）相平衡。NPPV的目标因临床背景而异。在哮喘或COPD急性失代偿期间，目标是通过卸载呼吸肌和增加肺泡通气来减少CO2，从而稳定动脉pH值，直到潜在问题可以逆转。当在低氧性ARF发作期间使用时，目标是确保足够的PaO 2，直到根本问题可以逆转。当持续应用于慢性呼吸衰竭患者时，NPPV的目标是提供足够的氧合和/或CO2消除，通过逆转肺不张或休息呼吸肌来维持生命。当间歇性应用于OHS患者时，目标是限制睡眠和体位，
Patients require ventilatory assistance to reduce the PaCO2 Fig. 1) and/or to improve oxygenation Fig. 2). If they can receive appropriate non-invasive ventilatory assistance, patients are spared the discomfort and risks associated with ETI. Although studies suggest that NPPV is associated with a reduced incidence of nosocomial pneumonia, methodological problems mandate re investigation of this issue. Potential benefits must be balanced against the discomfort of a nasal or facial mask and risks specific to NPPV eg, failure to provide sufficient oxygenation or CO2 elimination, eye or nasal trauma, gastric distension/aspiration). The goals of NPPV differ depending upon the clinical context. During acute decompensations of asthma or COPD, the goal is to reduce CO2 by unloading the respiratory muscles and augmenting alveolar ventilation, thereby stabilizing arterial pH until the underlying problem can be reversed. When employed during episodes of hypoxemic ARF the goal is to ensure an adequate PaO2 until the underlying problem can be reversed. When applied continuously to patients with chronic ventilatory failure the goal of NPPV is to provide sufficient oxygenation and/or CO2 elimination to sustain life by reversing atelectasis or resting the respiratory muscles. When applied intermittently to patients with OHS, the goal is to limit sleep-and position-in-