Creagh-Brown Bc, Shee Cd
Respiratory and Intensive Care Medicine, Royal Surrey County Hospital, Guildford, UK .
Chron Respir Dis. 2008;5(3):143-8. doi: 10.1177/1479972308089234.
The benefits of noninvasive ventilation (NIV) for acute hypercapnic respiratory failure caused by chronic obstructive pulmonary disease (COPD) are well recognized and consequently its use is widespread. Prognostication in advanced COPD is imperfect, limiting accurate identification of 'end-stage' COPD. Decisions regarding withholding invasive ventilation are largely dependent upon prognostication. In patients where 'invasive' ventilation is not considered to be in their best interests, NIV will be the ceiling of therapy. In this patient group, NIV is extremely valuable in reducing mortality and providing valuable symptomatic benefit. We discuss the use of NIV in the management of an acute exacerbation of 'end-stage' COPD where NIV is the ceiling of therapy, the use of advanced directives and the implications of the Mental Capacity Act 2005 on decisions regarding end-of-life care. We highlight areas where further research would be useful.
无创通气（NIV）用于慢性阻塞性肺疾病（COPD）所致急性高碳酸血症性呼吸衰竭的益处已得到充分认可，因此其应用广泛。晚期COPD的预后评估并不完美，限制了对“终末期”COPD的准确识别。关于不进行有创通气的决策很大程度上取决于预后评估。在那些认为“有创”通气不符合其最大利益的患者中，NIV将是治疗的上限。在这一患者群体中，NIV在降低死亡率和提供有价值的症状改善方面极具价值。我们讨论了在“终末期”COPD急性加重的管理中使用NIV（此时NIV是治疗的上限）、使用预立医嘱以及2005年《精神能力法案》对临终关怀决策的影响。我们强调了一些需要进一步研究的有用领域。
