Akingbola O A, Hopkins R L
Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA.
Pediatr Crit Care Med. 2001 Apr;2(2):164-9. doi: 10.1097/00130478-200104000-00011.
To review the clinical use of noninvasive positive pressure ventilation (NPPV) in both acute hypoxic and hypercarbic forms of pediatric respiratory failure, including its mechanism of action and implementation. DATA SOURCES: Studies were identified through a MEDLINE search using respiratory failure, pediatrics, noninvasive ventilation, and mechanical ventilation as key words. STUDY SELECTION: All original studies, including case reports, relating to the use of noninvasive positive pressure in pediatric respiratory failure were included. Because of the paucity of published literature on pediatric NPPV, no study was excluded. DATA EXTRACTION: Study design, numbers and diagnoses of patients, types of noninvasive ventilator, ventilator modes, outcome measures, and complications were extracted and compiled. DATA SYNTHESIS: For acute hypoxic respiratory failure, all the studies reported improvement in oxygenation indices and avoidance of endotracheal intubation. The average duration of NPPV therapy before noticeable clinical improvement was 3 hrs in most studies, and NPPV was applied continuously for 72 hrs before resolution of acute respiratory distress. In patients with acute hypercarbic respiratory failure, application of NPPV resulted in reduction of work of breathing, reduction in CO(2) tension, and increased serum bicarbonate and pH. These patients are older than patients in the acute hypoxic respiratory failure group and, in addition to improved blood gas indices, they reported improvement in subjective symptoms of dyspnea. Improvement in gas exchange abnormalities and subjective symptoms occurred within the same time span (the first 3 hrs) as in the acute hypoxic respiratory failure group. However, use of noninvasive techniques in patients with acute hypercarbic respiratory failure continued after resolution of acute symptoms. Complications related to protracted use of NPPV were common in this group. CONCLUSIONS: NPPV has limited benefits in a group of carefully selected pediatric patients with acute hypoxic and hypercarbic forms of respiratory failure. The routine use of this technique in pediatric respiratory failure needs to be studied in randomized controlled trials and better-defined patient subsets.
回顾无创正压通气（NPPV）在小儿呼吸衰竭的急性低氧和高碳酸血症形式中的临床应用，包括其作用机制和实施方法。资料来源：通过使用呼吸衰竭、儿科学、无创通气和机械通气作为关键词在MEDLINE中检索来确定研究。研究选择：纳入所有与小儿呼吸衰竭中无创正压通气使用相关的原始研究，包括病例报告。由于关于小儿NPPV的已发表文献较少，没有排除任何研究。资料提取：提取并汇总研究设计、患者数量和诊断、无创呼吸机类型、通气模式、结局指标和并发症。资料综合：对于急性低氧性呼吸衰竭，所有研究均报告氧合指数改善且避免了气管插管。在大多数研究中，临床明显改善前NPPV治疗的平均持续时间为3小时，急性呼吸窘迫缓解前NPPV持续应用72小时。在急性高碳酸血症性呼吸衰竭患者中，应用NPPV导致呼吸功降低、二氧化碳分压降低、血清碳酸氢盐和pH值升高。这些患者比急性低氧性呼吸衰竭组的患者年龄大，除血气指标改善外，他们报告呼吸困难的主观症状也有所改善。气体交换异常和主观症状的改善与急性低氧性呼吸衰竭组在同一时间段内（最初3小时）出现。然而，急性高碳酸血症性呼吸衰竭患者在急性症状缓解后仍继续使用无创技术。该组中与长期使用NPPV相关的并发症很常见。结论：NPPV在一组精心挑选的急性低氧和高碳酸血症形式呼吸衰竭的小儿患者中益处有限。需要在随机对照试验和更明确的患者亚组中研究该技术在小儿呼吸衰竭中的常规应用。
