Diez Ana R, Abbona Horacio, Ferrero Gerardo, Figueroa Casas Juan C, De Vega Marcelino, Lisanti Raul, Lopez Ana M, Menga Guillermo, Montiel Guillermo C, Perez Chada Daniel, Raimondi Alejandro C, Raimondi Guillermo A, Uribe Echevarria María Elisa, Vázquez Walter D
Sección Neumonología Crítica, Asociación Argentina de Medicina Respiratoria (AAMR).
Medicina (B Aires). 2005;65(5):437-57.
Non-invasive ventilation (NIV) is nowadays increasingly used. The significant decrease in tracheal intubation related complications makes it particularly attractive in patients with moderately acute respiratory failure (ARF) who still have some degree of respiratory autonomy. It has also been used to support patients with chronic respiratory failure. However, final outcomes are variable according to the conditions which determined its application. This Consensus was performed in order to review the evidence supporting the use of positive pressure NIV. The patho-physiological background of NIV and the equipment required technology are described. Available evidence clearly suggests benefits of NIV in acute exacerbation of chronic obstructive pulmonary disease (COPD) and in cardiogenic pulmonary edema (Recommendation A). When considering ARF in the setting of acute respiratory distress syndrome results are uncertain, unless dealing with immunosupressed patients (Recommendation B). Positive results are also shown in weaning of mechanical ventilation (MV), particularly regarding acute exacerbation of COPD patients (Recommendation A). An improved quality of life in chronic respiratory failure and a longer survival in restrictive disorders has also been shown (Recommendation B) while its benefit in stable COPD patients is still controversial (Recommendation C). NIV should be performed according to pre-established standards. A revision of NIV related complications is performed and the cost-benefit comparison with invasive MV is also considered.
如今，无创通气（NIV）的应用越来越广泛。气管插管相关并发症的显著减少使其在仍具有一定程度呼吸自主性的中度急性呼吸衰竭（ARF）患者中颇具吸引力。它也被用于支持慢性呼吸衰竭患者。然而，根据决定其应用的条件，最终结果存在差异。本共识旨在回顾支持使用正压无创通气的证据。描述了无创通气的病理生理背景和所需设备技术。现有证据清楚地表明无创通气在慢性阻塞性肺疾病（COPD）急性加重期和心源性肺水肿中具有益处（推荐A）。在急性呼吸窘迫综合征背景下考虑急性呼吸衰竭时，结果尚不确定，除非是免疫抑制患者（推荐B）。在机械通气（MV）撤机方面也显示出积极结果，特别是对于COPD急性加重患者（推荐A）。在慢性呼吸衰竭中生活质量得到改善，在限制性疾病中生存期延长也已得到证实（推荐B），而其在稳定期COPD患者中的益处仍存在争议（推荐C）。无创通气应按照既定标准进行。对无创通气相关并发症进行了修订，并考虑了与有创机械通气的成本效益比较。
