Schönhofer B
Institut Abteilung für Pneumologie und Internistische Intensivmedizin, Krankenhaus Oststadt-Heidehaus, Klinikum Region Hannover.
Dtsch Med Wochenschr. 2009 Mar;134(11):530-5. doi: 10.1055/s-0029-1208083. Epub 2009 Mar 3.
Non-invasive mechanical ventilation (NIV) has been employed alternatively to invasive mechanical ventilation (IMV) in acute treatment as well as in long-term domiciliary use. In hypercapnic acute respiratory failure (ARF), NIV significantly reduces intubation and mortality rates and should thus be preferred to IMV whenever possible and as quick as possible. On the other hand, NIV is not generally recommended in hypoxemic ARF. Strong evidence supports the use of domiciliary NIV in chronic respiratory failure caused by neuromuscular diseases or by thoracic restrictions. In contrast, its influence on long time survival in COPD patients is not clearly proven. Prescription of home NIV in COPD should therefore be confined to severe degrees of chronic respiratory failure. Adaptive servo ventilation is another ventilatory mode that is increasingly used in patients with chronic heart failure and Cheyne-Stokes respiration.
在急性治疗以及长期家庭使用中，无创机械通气（NIV）已被交替用于有创机械通气（IMV）。在高碳酸血症性急性呼吸衰竭（ARF）中，NIV可显著降低插管率和死亡率，因此在任何可能的情况下都应尽快优先选择NIV而非IMV。另一方面，在低氧血症性ARF中一般不推荐使用NIV。有力证据支持在由神经肌肉疾病或胸廓受限引起的慢性呼吸衰竭中使用家庭NIV。相比之下，其对慢性阻塞性肺疾病（COPD）患者长期生存的影响尚未得到明确证实。因此，COPD患者家庭NIV的处方应仅限于严重程度的慢性呼吸衰竭。适应性伺服通气是另一种越来越多地用于慢性心力衰竭和潮式呼吸患者的通气模式。
