Schönhofer B, Sortor-Leger S
Division of Pulmonary and Critical Care Medicine, Edward Hines, Jr., VA Hospital and Loyola University of Chicago, Hines 60141, USA.
Eur Respir J. 2002 Oct;20(4):1029-36. doi: 10.1183/09031936.02.00404202.
Noninvasive mechanical ventilation (NIV) has a long tradition for the treatment of chronic respiratory failure and more recently has also been applied in acute respiratory failure. Based on this experience both critical care ventilators and portable ventilators are used to perform NIV. The individual choice of ventilator type should depend on the patient's condition and also on the expertise of attending staff, therapeutic requirements and the location of care. The majority of studies have used pressure-targeted ventilation in the assist mode. Positive qualities of pressure support ventilation (PSV) are leak compensation, good patient/ventilator synchrony and the option of integrated positive end-expiratory pressure to counteract the effect of dynamic hyperinflation. In this article, some crucial issues concerning PSV (i.e. triggering into inspiration, pressurisation, cycling into expiration and carbon dioxide rebreathing) and some corrective measures are discussed. The parameters which should be monitored during noninvasive ventilation are presented. The interface between patient and ventilator is a crucial issue of noninvasive ventilation. Advantages and disadvantages of face and nasal masks are discussed. Finally, causes and possible remedies of significant air leaks and some technical accessories for noninvasive ventilation are dealt with.
无创机械通气（NIV）在治疗慢性呼吸衰竭方面有着悠久的历史，最近也被应用于急性呼吸衰竭的治疗。基于这一经验，重症监护呼吸机和便携式呼吸机都被用于进行无创机械通气。呼吸机类型的具体选择应取决于患者的病情，还应考虑医护人员的专业水平、治疗需求以及护理地点。大多数研究在辅助模式下采用压力目标通气。压力支持通气（PSV）的优点包括漏气补偿、良好的患者/呼吸机同步性以及可选择整合呼气末正压以抵消动态肺过度充气的影响。在本文中，讨论了有关压力支持通气的一些关键问题（即触发吸气、增压、切换到呼气以及二氧化碳重复吸入）和一些纠正措施。介绍了无创通气期间应监测的参数。患者与呼吸机之间的接口是无创通气的一个关键问题。讨论了面罩和鼻罩的优缺点。最后，探讨了严重漏气的原因及可能的解决方法，以及一些无创通气的技术配件。
