急性低氧性（非高碳酸血症性）呼吸衰竭的无创压力支持通气。呼吸中级重症监护病房的观察结果

Non-invasive pressure support ventilation in acute hypoxemic (non hypercapnic) respiratory failure. Observations in Respiratory Intermediate Intensive Care Unit.

作者信息

Mollica C, Brunetti G, Buscajoni M, Cecchini L, Maialetti E, Marazzi M, Principe R, Sabato R, Antonini V E

机构信息

Azienda Ospedaliera, S. Camillo-Forlanini, STIRS, Rome, Italy.

出版信息

Minerva Anestesiol. 2001 Mar;67(3):107-15.

PMID:11337642

Abstract

BACKGROUND

Non-invasive positive pressure support ventilation (NIPSV).

METHODS

In patients with acute hypoxaemic (PaO2/FiO2 &Mac178;100) non hypercapnic respiratory failure (ARF) admitted to a Respiratory Inter-mediate Intensive Care Unit of a general Hospital, between January 1993 and December 1997.

RESULTS

In 21 selected patients (PaO2/ FiO2T0=82+/-9) NIPSV improved PaO2 in 13/21 patients (Group A) and did not improve in 8/21 patients (Group B) (PaO2/FiO2T1=154+/-25 in Group A vs PaO2/FiO2T1=106+/-7.5 in Group B, p=0.00001). Upon admission the two groups did neither significantly differ for blood gas values (PaO2/FiO2T0=84+/-9.6 in Group A vs 79.8+/-8.7 in Group B), nor for clinical status (APACHE II=19.8+/-5 in Group A vs 24.6+/-7 in Group B). Shorter duration of NIPSV in Group B patients (11.2+/-19.7 hrs vs 35.3+/-32.3 hrs in Group A, p=0.047), in spite of a rise in PEEP (9.3+/-2.3 in Group B vs 5.5+/-2.4 in Group A, p=0.003) and Pressure Support (18.7+/-1.8 in Group B vs 15+/-3.2 in Group A, p=0.004) was due to onset of conditions which required shifting from NIPSV to endotracheal intubation (ETI).

OUTCOME

8/21 patients were successfully treated by only NIPSV. 8/21 patients were intubated. 5/21 patients dead in RIICU; 1 month survival: 9/21 patients. Side effects: mask intolerance (3/21); skin necrosis (1/21); pneumothorax (1/21).

CONCLUSIONS

NIPSV may be tried in ARF patients to improve PaO2 and avoid ETI.

摘要

背景

无创正压支持通气（NIPSV）。

方法

选取1993年1月至1997年12月期间入住一家综合医院呼吸中级重症监护病房的急性低氧血症（PaO2/FiO2≤100）非高碳酸血症呼吸衰竭（ARF）患者。

结果

在21例入选患者（初始PaO2/FiO2 = 82±9）中，13/21例患者（A组）的NIPSV改善了PaO2，8/21例患者（B组）未改善（A组T1时PaO2/FiO2 = 154±25，B组T1时PaO2/FiO2 = 106±7.5，p = 0.00001）。入院时，两组的血气值（A组T0时PaO2/FiO2 = 84±9.6，B组为79.8±8.7）和临床状况（A组急性生理与慢性健康状况评分II = 19.8±5，B组为24.6±7）均无显著差异。B组患者的NIPSV持续时间较短（11.2±19.7小时，A组为35.3±32.3小时，p = 0.047），尽管呼气末正压（PEEP）升高（B组为9.3±2.3，A组为5.5±2.4，p = 0.003）且压力支持升高（B组为18.7±1.8，A组为15±3.2，p = 0.004），但这是由于出现了需要从NIPSV转为气管插管（ETI）的情况。