New treatment of acute hypoxemic respiratory failure: Noninvasive pressure support ventilation delivered by helmet - A pilot controlled trial
New treatment of acute hypoxemic respiratory failure: Noninvasive pressure support ventilation delivered by helmet - A pilot controlled trial
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DOI：
10.1097/00003246-200203000-00019
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发表时间：
2002-03-01
影响因子：
8.8
通讯作者：
Proietti, R
中科院分区：
文献类型：
--
作者：
Antonelli, M;Conti, G;Proietti, R
目的：评估使用新型特殊头盔作为一线干预的无创压力支持通气（NPSV）治疗低氧性急性呼吸衰竭（ARF）患者的疗效，并与使用标准面罩的NPSV进行比较。设计和设置：前瞻性临床试验研究，在大学医院的三个重症监护室进行匹配对照组。患者和方法：入选33例无慢性阻塞性肺疾病和低氧血症ARF（定义为静息时严重呼吸困难，呼吸频率>30次/min，PaO 2：FiO（2）< 200，呼吸辅助肌主动收缩）的连续患者。通过头盔接受NPSV治疗的每例患者与通过面罩接受NPSV治疗的2例ARF对照组相匹配，根据简化的急性生理评分II、年龄、PaO 2/FiO（2）和入院时的动脉pH值进行选择。主要终点是气体交换的改善，气管插管的需要，以及与NPSV相关的并发症。结果：33例患者和66例对照组在基线时具有相似的特征。两组在NPSV后均改善了氧合。头盔组8例患者（24%）和面罩组21例患者（32%）（p = 0.3）NPSV失败并插管。头盔组中没有患者因技术不耐受而导致NPSV失败，而面罩组中有8例患者（38%）（p = 0.047）。与面罩组相比，头盔组与技术相关的并发症（皮肤坏死、胃扩张和眼睛刺激）较少（无患者vs. 14例患者（21%），p = 0.002）。头盔允许持续应用NPSV更长时间（p = .05）。在重症监护室，重症监护和住院死亡率的时间没有different.Conclusions：NPSV头盔成功地治疗低氧ARF，更好的耐受性和更少的并发症比面罩NPSV。
Objective: To assess the efficacy of noninvasive pressure support ventilation (NPSV) using a new special helmet as first-line intervention to treat patients with hypoxemic acute respiratory failure (ARF), in comparison to NPSV using standard facial mask.Design and Setting: Prospective clinical pilot investigation with matched control group in three intensive care units of university hospitals.Patients and Methods: Thirty-three consecutive patients without chronic obstructive pulmonary disease and with hypoxemic ARF (defined as severe dyspnea at rest, respiratory rate >30 breaths/min, PaO2:FiO(2) < 200, and active contraction of the accessory muscles of respiration) were enrolled. Each patient treated with NPSV by helmet was matched with two controls with ARF treated with NPSV via a facial mask, selected by simplified acute physiologic score II, age, PaO2/FiO(2), and arterial pH at admission. Primary end points were the improvement of gas exchanges, the need for endotracheal intubation, and the complications related to NPSV.Results: The 33 patients and the 66 controls had similar characteristics at baseline. Both groups improved oxygenation after NPSV. Eight patients (24%) in the helmet group and 21 patients (32%) in the facial mask group (p = .3) failed NPSV and were intubated. No patients failed NPSV because of intolerance of the technique in the helmet group in comparison with 8 patients (38%) in the mask group (p = .047). Complications related to the technique (skin necrosis, gastric distension, and eye irritation) were fewer in the helmet group compared with the mask group (no patients vs. 14 patients (21%), p = .002). The helmet allowed the continuous application of NPSV for a longer period of time (p = .05). Length of stay in the intensive care unit, intensive care, and hospital mortality were not different.Conclusions: NPSV by helmet successfully treated hypoxemic ARF, with better tolerance and fewer complications than facial mask NPSV.