Brochard L, Mancebo J, Elliott M W
Henri Mondor Hospital, Assistance Publique-Hĵspitaux de Paris, Paris XII Université, Créteil, France.
Eur Respir J. 2002 Apr;19(4):712-21. doi: 10.1183/09031936.02.00295502.
Noninvasive ventilation (NIV) has emerged as a significant advance in the management of respiratory failure. There is now a wide body of prospective randomized-controlled trial data to support its use, particularly in the management of patients with acute or respiratory failure due to exacerbations of chronic obstructive pulmonary disease (COPD). Its successful application results in a more rapid resolution of the physiological derangements, reduces the need for intubation and, in larger studies, improves survival. A reduction in the number of infectious complications is a particular advantage. In patients with acute exacerbations of COPD there is evidence of benefit when NIV is introduced earlier in the course of the illness than would be the case for invasive ventilation and it should now be considered even with mild acidosis (pH<7.35) and tachypnoea (respiratory rate >23 breaths x min(-1)) after initial medical therapy. There is less clinical-trial data in patients with hypoxaemic respiratory failure, but again as with COPD those with less severe physiological disturbance are more likely to benefit. By contrast noninvasive continuous positive airways pressure, while being widely used has not been shown to reduce the need for intubation or to improve survival in patients with hypoxaemic respiratory failure, with the exception of acute cardiogenic pulmonary oedema. Noninvasive ventilation has been a real advance in the treatment of the critically ill. Most of the studies published to date, have excluded patients needing immediate intubation and it should be viewed as a complimentary technique rather than an alternative to invasive ventilation. It is best viewed as a means of preventing the need for endotracheal intubation and as a result should be introduced earlier than would be the case for invasive ventilation.
无创通气（NIV）已成为呼吸衰竭管理方面的一项重大进展。目前有大量前瞻性随机对照试验数据支持其应用，尤其是在慢性阻塞性肺疾病（COPD）急性加重导致的急性或呼吸衰竭患者的管理中。其成功应用能更迅速地纠正生理紊乱，减少插管需求，并且在规模更大的研究中能提高生存率。减少感染并发症的数量是一个特别的优势。在COPD急性加重患者中，有证据表明在疾病过程中比有创通气更早引入NIV有益，现在即使在初始药物治疗后出现轻度酸中毒（pH<7.35）和呼吸急促（呼吸频率>23次/分钟）时也应考虑使用。在低氧性呼吸衰竭患者中临床试验数据较少，但与COPD患者一样，生理紊乱较轻的患者更可能获益。相比之下，无创持续气道正压通气虽然被广泛使用，但除急性心源性肺水肿外，尚未被证明能减少低氧性呼吸衰竭患者的插管需求或提高生存率。无创通气在危重症治疗方面确实是一项进展。迄今为止发表的大多数研究都排除了需要立即插管的患者，它应被视为一种辅助技术，而非有创通气的替代方法。最好将其视为一种预防气管插管需求的手段，因此应比有创通气更早引入。
