Rocco Monica, Dell'Utri Donatella, Morelli Andrea, Spadetta Gustavo, Conti Giorgio, Antonelli Massimo, Pietropaoli Paolo
Dipartimento di Anestesia e Rianimazione, Policlinico Umberto I, Viale del Policlinico 155, 00161 Rome, Italy.
Chest. 2004 Nov;126(5):1508-15. doi: 10.1378/chest.126.5.1508.
To compare the efficacy of noninvasive positive pressure ventilation (NPPV) by helmet and face mask in immunocompromised patients with hypoxemic acute respiratory failure (ARF).
Case-control study.
The general ICU of a university hospital.
Nineteen immunocompromised patients (hematologic malignancies [n = 8], solid-organ recipients [n = 8], AIDS [n = 3]) with hypoxemic ARF, fever, and lung infiltrates were treated with NPPV delivered by a helmet. Nineteen immunocompromised patients matched for diagnosis, age, simplified acute physiology score II, and Pao(2)/fraction of inspired oxygen (Fio(2)) receiving NPPV through a facial mask served as case-control subjects.
The use of NPPV delivered via helmet was as effective as NPPV delivered via face mask in avoiding endotracheal intubations (intubation rate, 37% vs 47%, respectively; p = 0.37) and improving gas exchange; 14 patients (74%) in the helmet group showed a sustained improvement in Pao(2)/Fio(2) ratio (ability to increase Pao(2)/Fio(2) ratio > 200, or an increase > 100 from the baseline) in comparison with 7 patients (34%) in the mask group (p = 0.02), whose Pao(2)/Fio(2) at treatment discontinuation was higher (p = 0.02) and had fewer complications related to NPPV (ie, skin necrosis, p = 0.01). Moreover, the patients receiving ventilation via helmet required significantly less NPPV discontinuations in the first 24 h of application (p < 0.001) than patients receiving ventilation via face mask.
The helmet may represent a valid alternative to a face mask in immunocompromised patients with lung infiltrates and hypoxemic ARF, increasing the patient's tolerance (ie, the number of hours of continuous NPPV use without interruptions) and decreasing the rate of complications directly related to the administration of NPPV.
比较头盔式与面罩式无创正压通气（NPPV）在免疫功能低下的低氧性急性呼吸衰竭（ARF）患者中的疗效。
病例对照研究。
一所大学医院的综合重症监护病房。
19例免疫功能低下的低氧性ARF患者（血液系统恶性肿瘤患者8例、实体器官移植受者8例、艾滋病患者3例），伴有发热和肺部浸润，接受头盔式NPPV治疗。19例诊断、年龄、简化急性生理学评分II以及动脉血氧分压（Pao₂）/吸入氧分数（Fio₂）相匹配的免疫功能低下患者，通过面罩接受NPPV治疗，作为病例对照。
头盔式NPPV在避免气管插管（插管率分别为37%和47%；p = 0.37）和改善气体交换方面与面罩式NPPV同样有效；头盔组14例患者（74%）的Pao₂/Fio₂比值持续改善（Pao₂/Fio₂比值增加>200，或较基线增加>100），而面罩组为7例患者（34%）（p = 0.02），面罩组治疗停止时的Pao₂/Fio₂更高（p = 0.02），且与NPPV相关的并发症更少（即皮肤坏死，p = 0.01）。此外，与通过面罩接受通气的患者相比，通过头盔接受通气的患者在应用的最初24小时内NPPV中断显著更少（p < 0.001）。
对于有肺部浸润和低氧性ARF的免疫功能低下患者，头盔可能是面罩的有效替代方式，可提高患者耐受性（即持续无间断使用NPPV的小时数），并降低与NPPV给药直接相关的并发症发生率。
