Wagner T
Pneumologie/Allergologie, Klinikum der Johann Wolfgang Goethe-Universität, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
Internist (Berl). 2006 Apr;47(4):342, 344-6, 348-50, passim. doi: 10.1007/s00108-006-1589-8.
Bronchial obstruction due to one of the major pulmonary diseases asthma, COPD, or emphysema are a common problem in intensive care medicine as the leading cause or as comorbidity. While in pharmacological therapy no major changes have occurred during the last few years, two major advances have been reached in ventilation therapy which are in the focus of this review. First the non invasive ventilation (NIV) has been shown to prove efficient in treating acute on chronic respiratory failure in COPD patients and is capable of shortening the duration of hospital stay. In addition NIV can be used successfully in weaning after long time ventilator therapy and improve prognosis in COPD patients. Secondly the strategy of invasive ventilation therapy has changed significantly. "Permissive hypercapnia" is unequivocally established in severe bronchial obstruction in situations of limited ventilation. When intrinsic PEEP and elevated airway resistance are present PEEP may be useful and the upper limit of airways peak pressure that we are used to in "protective ventilation" of ARDS patients can be necessary and useful to exceed.
由主要肺部疾病之一哮喘、慢性阻塞性肺疾病（COPD）或肺气肿导致的支气管阻塞是重症监护医学中的常见问题，是主要病因或合并症。尽管在过去几年药理治疗方面没有重大变化，但通气治疗取得了两项重大进展，这也是本综述的重点。首先，无创通气（NIV）已被证明在治疗COPD患者的慢性呼吸衰竭急性发作方面有效，并且能够缩短住院时间。此外，NIV可成功用于长时间机械通气治疗后的撤机，并改善COPD患者的预后。其次，有创通气治疗策略发生了显著变化。在通气受限的严重支气管阻塞情况下，“允许性高碳酸血症”已明确确立。当存在内源性呼气末正压（PEEP）和气道阻力升高时，PEEP可能有用，并且在ARDS患者的“保护性通气”中我们习惯的气道峰值压力上限可能需要且有助于突破。
