Vitacca Michele, Barbano Luca, D'Anna Silvestro, Porta Roberto, Bianchi Luca, Ambrosino Nicolino
Pulmonary Division, Scientific Institute, Fondazione Salvatore Maugeri IRCCS, I-25064 Gussago (BS), Italy.
Chest. 2002 Dec;122(6):2105-14. doi: 10.1378/chest.122.6.2105.
To compare patient-ventilator interaction and comfort in patients with chronic ventilatory failure (CVF) who are undergoing noninvasive positive-pressure ventilation with five different commercial bilevel pressure home ventilators. Also, we wanted to evaluate the short-term effects of the five ventilators on physiologic variables, namely, breathing patterns and inspiratory muscles.
Randomized, controlled physiologic study.
Pulmonary division of a rehabilitation institution.
Twenty-eight patients with CVF due to COPD (17 patients) and restrictive chest wall diseases (11 patients).
Sensation of comfort, breathing patterns and minute ventilation (E), respiratory muscles and mechanics, and patient-ventilator interaction during both unassisted and assisted ventilation with the five ventilators applied randomly.
The five ventilators showed different flow and pressure waveforms. The level of comfort was somehow different among the studied ventilators. When compared to unassisted ventilation, all ventilators induced a significant increase in E (p < 0.01) without any significant difference among ventilators. Use of the five ventilators resulted in significant differences in peak airway opening pressure (Pao,peak) but not in mean airway opening pressure computed over a period of 1 min (PTPao,min), and in a duty cycle. Ineffective efforts (IEs) were similar among the studied ventilators. In comparison with unassisted ventilation, all ventilators induced significant reductions in inspiratory muscle effort (p < 0.001). No significant relationship was found between level of comfort and PTPao,min, Pao,peak, or the number of IEs.
In stable, awake patients with CVF, all of the studied ventilators were well-tolerated, although with a great intersubject variability in comfort, and performed well in terms of improvement in E and inspiratory muscle unloading, thus fulfilling the aims of mechanical ventilation. This effect was obtained with similar levels of PTPao,min, despite the fact that Pao,peak was different among some ventilators. The number of IEs was similar among the studied ventilators.
比较使用五种不同商用双水平压力家用呼吸机进行无创正压通气的慢性通气衰竭（CVF）患者的人机交互及舒适度。此外，我们还想评估这五种呼吸机对生理变量的短期影响，即呼吸模式和吸气肌。
随机对照生理研究。
一家康复机构的肺科。
28例因慢性阻塞性肺疾病（COPD）（17例）和限制性胸壁疾病（11例）导致CVF的患者。
舒适度、呼吸模式和分钟通气量（E）、呼吸肌和力学指标，以及在随机应用这五种呼吸机进行自主通气和辅助通气期间的人机交互情况。
这五种呼吸机显示出不同的流量和压力波形。在所研究的呼吸机中，舒适度水平存在一定差异。与自主通气相比，所有呼吸机均使E显著增加（p < 0.01），但各呼吸机之间无显著差异。使用这五种呼吸机导致气道开口峰值压力（Pao,peak）存在显著差异，但在1分钟内计算的平均气道开口压力（PTPao,min）无显著差异，且在占空比方面存在差异。在所研究的呼吸机中，无效努力（IEs）相似。与自主通气相比，所有呼吸机均使吸气肌努力显著降低（p < 0.001）。舒适度水平与PTPao,min、Pao,peak或IEs数量之间未发现显著关系。
在稳定、清醒的CVF患者中，尽管舒适度存在较大个体差异，但所有研究的呼吸机耐受性良好，在改善E和减轻吸气肌负荷方面表现良好，从而实现了机械通气的目标。尽管某些呼吸机的Pao,peak不同，但在PTPao,min水平相似的情况下获得了这种效果。在所研究的呼吸机中，IEs数量相似。
