Agarwal R, Malhotra P, Gupta D
Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
Emerg Med J. 2006 Feb;23(2):e9. doi: 10.1136/emj.2004.020438.
Noninvasive ventilation (NIV) is the provision of ventilatory support without the need for an invasive airway, and has revolutionized the management of patients with diverse forms of respiratory failure. The advantages of NIV include improved patient comfort and reduced need for sedation, while avoiding the complications of endotracheal intubation, including upper airway trauma, sinusitis, otitis, and nosocomial pneumonia. In selected patients, NIV has also been shown to improve survival. The role of NIV in acute severe asthma is at best controversial. In this case report, we describe a patient with acute severe asthma who was initially managed and failed with NIV, and was successfully managed with invasive ventilation. We also review the pathophysiological mechanisms of benefit of NIV in acute severe asthma, and the current literature on the use of NIV in acute asthma. In conclusion, a trial of NIV in acute asthma may be justified in carefully selected and monitored patients who do not respond to initial medical therapy. However, as its role is not clear and as the condition of an asthmatic patient may deteriorate abruptly, extreme caution is advisable to recognize failure of NIV as in the case presented here. Facilities for immediate endotracheal intubation and next level of treatment should be readily available.
无创通气（NIV）是在无需建立有创气道的情况下提供通气支持，它彻底改变了对各种形式呼吸衰竭患者的治疗方式。无创通气的优点包括提高患者舒适度以及减少镇静需求，同时避免气管插管的并发症，如气道上部创伤、鼻窦炎、中耳炎和医院获得性肺炎。在特定患者中，无创通气也已被证明可提高生存率。无创通气在急性重度哮喘中的作用充其量存在争议。在本病例报告中，我们描述了一名急性重度哮喘患者，该患者最初采用无创通气治疗但失败，随后通过有创通气成功治疗。我们还回顾了无创通气在急性重度哮喘中发挥作用的病理生理机制，以及目前关于无创通气在急性哮喘中应用的文献。总之，对于精心挑选并进行监测、对初始药物治疗无反应的患者，在急性哮喘中试用无创通气可能是合理的。然而，由于其作用尚不清楚，且哮喘患者病情可能突然恶化，因此在识别无创通气失败时应极其谨慎，如此处所述病例。应随时具备立即进行气管插管和进一步治疗的设施。
