Wysocki Marc, Richard Jean-Christophe, Meshaka Patrick
Réanimation Polyvalente, Institut Mutualiste Montsouris, Paris, France.
Crit Care Med. 2002 Feb;30(2):323-9. doi: 10.1097/00003246-200202000-00010.
To compare short-term administration of noninvasive proportional assist ventilation (NIV-PAV) and pressure support ventilation (NIV-PSV).
Prospective, crossover, randomized study.
Medicosurgical intensive care unit in a nonteaching hospital.
Twelve chronic obstructive pulmonary disease patients admitted for hypercapnic acute respiratory failure.
NIV-PSV and NIV-PAV given in a randomized order after baseline evaluation in continuous positive airway pressure. Using a flow-triggering ventilator, NIV-PAV was adjusted using the runaway method and compared with NIV-PSV at similar peak inspiratory airway pressure.
Flow, airway pressure, and changes in esophageal pressure were measured and the tidal volume, the patient's inspiratory work of breathing, and the esophageal pressure--time product were calculated. Arterial pH and PaCO(2) were measured and breathing comfort was assessed using a visual analogic scale. Peak inspiratory airway pressure (17 +/- 3 cm H(2)O) and tidal volume were similarly increased with the two modalities with no change in respiratory rate. The change in esophageal pressure was similarly decreased (from 20 +/- 8 cm H(2)O in continuous positive airway pressure to 12 +/- 7 in NIV-PSV and 10 +/- 5 cm H(2)O in NIV-PAV) as well as inspiratory muscle effort indexes. Arterial pH and PaCO(2) were similarly improved. Breathing comfort was significantly improved in NIV-PAV (+38 +/- 38%) but not in NIV-PSV (+11 +/- 23%). The tidal volume was more variable in NIV-PAV (89 +/- 18%) than in NIV-PSV (15 +/- 8%) and changes in tidal volume variability were significantly correlated (p =.02) with changes in breathing comfort.
In chronic obstructive pulmonary disease patients with hypercapnic acute respiratory failure, NIV-PAV was able to unload inspiratory muscles similarly to NIV-PSV but may be more comfortable than NIV-PSV.
比较无创比例辅助通气（NIV-PAV）和压力支持通气（NIV-PSV）的短期应用效果。
前瞻性、交叉、随机研究。
一家非教学医院的内科-外科重症监护病房。
12例因高碳酸血症急性呼吸衰竭入院的慢性阻塞性肺疾病患者。
在持续气道正压通气基线评估后，以随机顺序给予NIV-PSV和NIV-PAV。使用流量触发通气机，采用失控法调整NIV-PAV，并在相似的吸气气道峰压下与NIV-PSV进行比较。
测量流量、气道压力和食管压力变化，计算潮气量、患者吸气呼吸功和食管压力-时间乘积。测量动脉pH值和PaCO₂，并使用视觉模拟量表评估呼吸舒适度。两种通气模式下吸气气道峰压（17±3 cm H₂O）和潮气量均有相似增加，呼吸频率无变化。食管压力变化以及吸气肌努力指数同样降低（从持续气道正压通气时的20±8 cm H₂O降至NIV-PSV时的12±7 cm H₂O和NIV-PAV时的10±5 cm H₂O）。动脉pH值和PaCO₂同样得到改善。NIV-PAV组呼吸舒适度显著改善（+38±38%），而NIV-PSV组未显著改善（+11±23%）。NIV-PAV组潮气量变异性（89±18%）大于NIV-PSV组（15±8%），潮气量变异性变化与呼吸舒适度变化显著相关（p = 0.02）。
在高碳酸血症急性呼吸衰竭的慢性阻塞性肺疾病患者中，NIV-PAV与NIV-PSV一样能够减轻吸气肌负荷，但可能比NIV-PSV更舒适。
