Sarullo Filippo Maria, D'Alfonso Giovanni, Brusca Ignazio, De Michele Piero, Taormina Andrea, Di Pasquale Pietro, Castello Antonio
Dipartimento di Cardiologia, Ospedale Buccheri La Ferla Fatebenefratelli, Palermo.
Monaldi Arch Chest Dis. 2004 Mar;62(1):7-11.
Non-invasive positive pressure ventilation (NIPPV) is an effective treatment for acute respiratory failure in patients with chronic obstructive pulmonary disease. We assessed the efficacy and safety of this therapy in acute cardiogenic pulmonary edema (ACPE).
In addition to routine therapy consisting of oxygen, nitrates and diuretics, 60 patients (39 male, 21 female, mean age 72.5 +/- 15.8 years) were started on full mask NIPPV using a Sullivan VPAP II ventilator delivering pressure support 15 cm H2O, PEEP 5 cm H2O, FiO2 100%. Pressure support were titrated to achieve oxygen saturation (SaO2) > 95%. Physiological measurements were obtained in the first 2 h and at 3 h, 4 h, and 10 h. Outcome measures included arterial blood gas (ABG), Borg dyspnea score, vital signs, and need for endotracheal intubation (ETI).
Initial mean values on FiO2 100% by non nonrebreather mask: pH 7.11 +/- 0.25, paCO2 67.7 +/- 17.5 mmHg, paO2 71.5 +/- 29.7 mmHg, SaO2 83 +/- 12%, lactate concentrations 4.7 +/- 2.3 mmol/L, Borg score 8.6 +/- 1.3, respiratory rate (RR) 41 +/- 7. At 60 minutes of NIPPV, improvement was statistically significant: pH 7.35 +/- 0.18 (difference 0.24; p < 0.0001), paCO2 43 +/- 13 mmHg (difference 24.7; p < 0.0001), paO2 102 +/- 10 mmHg (difference 30.5; p < 0.0001), SaO2 99 +/- 5% (difference 16; p < 0.0001), lactate concentrations 1.2 +/- 0.8 (difference 3.5; p < 0.0001) Borg score 3.6 +/- 0.9 (difference 5; p < 0.0001), RR 24.6 +/- 5 (difference 17.1; p < 0.0001). NIPPV duration ranged from 40 minutes to 24 hours (median 3 hours, 30 minutes). Fifty-six patients (93.4%) improved allowing cessation of NIPPV. ETI was required in four (6.6%) of 60 patients. There were non complications of NIPPV.
In this study of acute cardiogenic pulmonary edema, NIPPV is an effective treatment and may help prevent ETI.
无创正压通气（NIPPV）是治疗慢性阻塞性肺疾病患者急性呼吸衰竭的有效方法。我们评估了该疗法在急性心源性肺水肿（ACPE）中的疗效和安全性。
除了采用吸氧、硝酸盐和利尿剂的常规治疗外，60例患者（男性39例，女性21例，平均年龄72.5±15.8岁）开始使用Sullivan VPAP II呼吸机进行全面罩NIPPV治疗，提供压力支持15 cm H₂O、呼气末正压5 cm H₂O、吸入氧浓度100%。调整压力支持以使氧饱和度（SaO₂）>95%。在最初2小时以及3小时、4小时和10小时进行生理指标测量。观察指标包括动脉血气（ABG）、Borg呼吸困难评分、生命体征以及气管插管（ETI）需求。
通过非重复呼吸面罩吸入100%氧气时的初始平均值：pH 7.11±0.25，动脉血二氧化碳分压（PaCO₂）67.7±17.5 mmHg，动脉血氧分压（PaO₂）71.5±29.7 mmHg，SaO₂ 83±12%，乳酸浓度4.7±2.3 mmol/L，Borg评分8.6±1.3，呼吸频率（RR）41±7。NIPPV治疗60分钟时，改善具有统计学意义：pH 7.35±0.18（差值0.24；p<0.0001），PaCO₂ 43±13 mmHg（差值24.7；p<0.0001），PaO₂ 102±10 mmHg（差值30.5；p<0.0001），SaO₂ 99±5%（差值16；p<0.0001），乳酸浓度1.2±0.8（差值3.5；p<0.0001），Borg评分3.6±0.9（差值5；p<0.0001），RR 24.6±5（差值17.1；p<0.0001）。NIPPV持续时间为40分钟至24小时（中位数3小时30分钟）。56例患者（93.4%）病情改善，可停止NIPPV治疗。60例患者中有4例（6.6%）需要进行气管插管。NIPPV无并发症发生。
在这项关于急性心源性肺水肿的研究中，NIPPV是一种有效的治疗方法，可能有助于预防气管插管。
