Zhonghua Jie He He Hu Xi Za Zhi. 2006 Jan;29(1):14-8.
To evaluate the feasibility and the efficacy of early extubation and sequential noninvasive mechanical ventilation (MV) switched by pulmonary infection control window (PIC window) in chronic obstructive pulmonary disease (COPD) with exacerbated hypercapnic respiratory failure.
Respiratory or Medical Intensive Care Units (RICU/MICU) of 12 teaching hospitals in China participated in this study. COPD patients with severe hypercapnic respiratory failure exacerbated by pulmonary infection, and for whom intubation and MV were indicated, were enrolled in the study. PIC window was defined as the time point when pulmonary infection was considered under control based on clinical parameters. At PIC window, all the cases were randomly assigned to sequential MV group or conventional MV group. The invasive MV duration, ventilator-associated pneumonia (VAP), days in ICU and mortality rate in both groups were measured.
Ninety cases were enrolled. Compared with conventional MV group (n = 43) sequential MV group (n = 47) had shorter duration of invasive MV [(6.4 +/- 4.4), (11.3 +/- 6.2) d, P = 0.000], lower rate of VAP (3/47, 12/43, P = 0.014), fewer days in ICU [(12 +/- 8), (16 +/- 11) d, P = 0.047] and lower mortality rate (1/47, 7/43, P = 0.025).
Early extubation followed by non-invasive MV initiated at the point of PIC window may decrease the duration of invasive MV and improve the prognosis.
评估在慢性阻塞性肺疾病（COPD）合并高碳酸血症性呼吸衰竭急性加重期患者中，早期拔管并通过肺部感染控制窗（PIC窗）切换为序贯无创机械通气（MV）的可行性和疗效。
中国12家教学医院的呼吸或内科重症监护病房（RICU/MICU）参与了本研究。纳入因肺部感染加重而出现严重高碳酸血症性呼吸衰竭且需要插管和MV的COPD患者。PIC窗定义为根据临床参数判断肺部感染得到控制的时间点。在PIC窗时，所有病例随机分为序贯MV组或传统MV组。测量两组的有创MV持续时间、呼吸机相关性肺炎（VAP）、ICU住院天数和死亡率。
共纳入90例患者。与传统MV组（n = 43）相比，序贯MV组（n = 47）的有创MV持续时间更短[（6.4±4.4），（11.3±6.2）天，P = 0.000]，VAP发生率更低（3/47，12/43，P = 0.014），ICU住院天数更少[（12±8），（16±11）天，P = 0.047]，死亡率更低（1/47，7/43，P = 0.025）。
在PIC窗时进行早期拔管并随后启动无创MV可缩短有创MV持续时间并改善预后。
