Garpestad Erik, Brennan John, Hill Nicholas S
Division of Pulmonary, Critical Care and Sleep Medicine, Tufts-New England Medical Center, 750 Washington St, Boston, MA 02111, USA.
Chest. 2007 Aug;132(2):711-20. doi: 10.1378/chest.06-2643.
Noninvasive ventilation (NIV), the provision of ventilatory assistance without an artificial airway, has emerged as an important ventilatory modality in critical care. This has been fueled by evidence demonstrating improved outcomes in patients with respiratory failure due to COPD exacerbations, acute cardiogenic pulmonary edema, or immunocompromised states, and when NIV is used to facilitate extubation in COPD patients with failed spontaneous breathing trials. Numerous other applications are supported by weaker evidence. A trial of NIV is justified in patients with acute respiratory failure due to asthma exacerbations and postoperative states, extubation failure, hypoxemic respiratory failure, or a do-not-intubate status. Patients must be carefully selected according to available guidelines and clinical judgment, taking into account risk factors for NIV failure. Patients begun on NIV should be monitored closely in an ICU or other suitable setting until adequately stabilized, paying attention not only to vital signs and gas exchange, but also to comfort and tolerance. Patients not having a favorable initial response to NIV should be considered for intubation without delay. NIV is currently used in only a select minority of patients with acute respiratory failure, but with technical advances and new evidence on its proper application, this role is likely to further expand.
无创通气（NIV），即在不使用人工气道的情况下提供通气支持，已成为重症监护中一种重要的通气方式。有证据表明，对于慢性阻塞性肺疾病（COPD）急性加重、急性心源性肺水肿或免疫功能低下导致呼吸衰竭的患者，以及在COPD患者自主呼吸试验失败时使用NIV促进拔管的情况，其预后有所改善，这推动了NIV的应用。其他众多应用的证据则相对较弱。对于因哮喘急性加重、术后状态、拔管失败、低氧性呼吸衰竭或拒绝插管状态导致急性呼吸衰竭的患者，进行NIV试验是合理的。必须根据现有指南和临床判断，仔细挑选患者，并考虑NIV失败的风险因素。开始接受NIV治疗的患者应在重症监护病房（ICU）或其他合适的环境中密切监测，直至病情充分稳定，不仅要关注生命体征和气体交换，还要关注舒适度和耐受性。对NIV初始反应不佳的患者应立即考虑插管。目前，NIV仅用于少数急性呼吸衰竭患者，但随着技术进步以及关于其正确应用的新证据出现，这一作用可能会进一步扩大。
