RANDOMIZED, PROSPECTIVE TRIAL OF NONINVASIVE POSITIVE PRESSURE VENTILATION IN ACUTE RESPIRATORY-FAILURE
RANDOMIZED, PROSPECTIVE TRIAL OF NONINVASIVE POSITIVE PRESSURE VENTILATION IN ACUTE RESPIRATORY-FAILURE
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DOI：
10.1164/ajrccm.151.6.7767523
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发表时间：
1995-06-01
影响因子：
24.7
通讯作者：
HILL, NS
中科院分区：
文献类型：
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作者：
KRAMER, N;MEYER, TJ;HILL, NS
最近的研究表明，无创正压通气（NPPV）管理的鼻或口鼻面罩，避免了气管插管的需要，迅速改善生命体征，气体交换，呼吸困难的感觉，并可能降低死亡率在选定的急性呼吸衰竭患者，但很少有对照试验已经完成。本研究采用随机前瞻性设计，评价NPPV加标准治疗与单独标准治疗在急性呼吸衰竭患者中的可能获益。接受NPPV的患者舒适地配备有连接到BIPAP呼吸辅助装置（Respironics，Inc.，Murrysville，PA），标准治疗包括主治医生认为必要的所有其他治疗，包括气管内插管。插管的需要从标准治疗组的73%（15例患者中的11例）降低到NPPV组的31%（16例患者中的5例，p < 0.05）。在慢性阻塞性肺疾病（COPD）患者中，这种减少更为显著，12名对照患者中有8名（67%）需要插管，而11名NPPV患者中有1名（9%）需要插管（fp < 0.05）。NPPV组患者在1 h内心率和呼吸频率显著低于对照组患者，在前6 h内PaO2显著改善。呼吸困难评分和最大吸气压NPPV组在6 h时优于对照组，两组护士和治疗师在床边的时间相似。呼吸机使用的持续时间、住院时间、死亡率和住院费用也相似。鼻NPPV耐受性良好，并发症很少且轻微。我们的结论是，鼻NPPV减少了急性呼吸功能不全患者插管的需要，否则稳定，特别是那些与COPD。
Recent studies suggest that noninvasive positive pressure ventilation (NPPV) administered by nasal or oronasal mask avoids the need for endotracheal intubation, rapidly improves vital signs, gas exchange, and sense of dyspnea, and may reduce mortality in selected patients with acute respiratory failure, but few controlled trials have been done. The present study used a randomized prospective design to evaluate the possible benefits of NPPV plus standard therapy versus standard therapy alone in patients with acute respiratory failure. Patients to receive NPPV were comfortably fitted with a standard nasal mask connected to a BIPAP ventilatory assist device (Respironics, Inc., Murrysville, PA) in the patient flow-triggered/time-triggered (S/T) mode, and standard therapy consisted of all other treatments deemed necessary by the primary physician, including endotracheal intubation. The need for intubation was reduced from 73% in the standard therapy group (11 of 15 patients) to 31% in the NPPV group (5 of 16 patients, p < 0.05). Among chronic obstructive pulmonary disease (COPD) patients, the reduction was even more striking, with 8 of 12 (67%) control patients requiring intubation compared with 1 of 11 (9%) NPPV patients fp < 0.05). Heart and respiratory rates were significantly lower in the NPPV group than in control patients within 1 h, and PaO2 was significantly improved in the NPPV group for the first 6 h. Dyspnea scores and maximal inspiratory pressures were better in the NPPV than in control patients at 6 h, and nurses and therapists spent similar amounts of time at the bedside for both groups. Duration of ventilator use, hospital stays, mortality rates, and hospital charges were also similar Nasal NPPV was well tolerated, and complications were few and minor. We conclude that nasal NPPV reduces the need for intubation in patients with acute respiratory insufficiency who are otherwise stable, particularly those with COPD.