Hess Dean R, Pang Jessica M, Camargo Carlos A
Respiratory Care Services, Ellison 401, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
Respir Care. 2009 Oct;54(10):1306-12.
To determine the frequency of, and barriers to, use of noninvasive ventilation (NIV) for adult patients with acute asthma, chronic obstructive pulmonary disease (COPD), and congestive heart failure (CHF) in academic emergency departments (EDs).
A survey instrument was developed by the authors, pilot tested, and distributed to one physician (MD) and one respiratory therapist (RT) at the 132 hospitals with emergency medicine residencies.
The response rate was 90%. Ninety-nine percent of RTs and 64% of MDs are very familiar with NIV (P<.001). The reported time needed to initiate NIV was <10 min for 41% of sites (<20 min for 89%). Compared to the time requirement in other clinical areas, 60% of RTs reported that NIV "takes no additional time" in the ED. An RT is always present in 38% the EDs, and equipment for NIV is readily available in 76% of the EDs. The majority reported that NIV use is about right for acute COPD, CHF, and asthma. NIV is used infrequently for asthma (89% reported use in <20% of these patients), while 66% reported use in >20% of COPD patients and 67% reported use in >20% of CHF patients (P<.001, as compared to asthma). The perceived utility of NIV was significantly different between the 3 diagnoses (P<.001); there was more uncertainty about the utility of NIV for asthma. Bilevel ventilators and oronasal masks are most commonly used for NIV. Nearly all of the centers administer bronchodilators in-line with NIV.
Consistent with available evidence, NIV use is more common in the ED for acute COPD and CHF than for acute asthma. Barriers to greater use of NIV in the ED include physician familiarity, availability of RT and equipment in the ED, and time required for NIV. For acute asthma, uncertainty about therapeutic benefits remains a challenge.
确定学术性急诊科中成年急性哮喘、慢性阻塞性肺疾病（COPD）和充血性心力衰竭（CHF）患者使用无创通气（NIV）的频率及障碍。
作者自行设计了一份调查问卷，进行预试验后分发给132家设有急诊医学住院医师培训项目的医院的一名内科医生（MD）和一名呼吸治疗师（RT）。
回复率为90%。99%的呼吸治疗师和64%的内科医生对无创通气非常熟悉（P<0.001）。据报告，41%的机构启动无创通气所需时间<10分钟（89%<20分钟）。与其他临床区域的时间要求相比，60%的呼吸治疗师报告称在急诊科无创通气“不额外耗时”。38%的急诊科始终有呼吸治疗师在场，76%的急诊科无创通气设备随时可用。大多数人报告称，无创通气用于急性慢性阻塞性肺疾病、充血性心力衰竭和哮喘的情况大致合适。无创通气在哮喘患者中使用较少（89%报告称在<20%的此类患者中使用），而66%报告在>20%的慢性阻塞性肺疾病患者中使用，67%报告在>20%的充血性心力衰竭患者中使用（与哮喘相比，P<0.001）。三种诊断中无创通气的感知效用存在显著差异（P<0.001）；对于无创通气在哮喘治疗中的效用存在更多不确定性。双水平通气机和口鼻面罩最常用于无创通气。几乎所有中心都在无创通气时联合使用支气管扩张剂。
与现有证据一致，在急诊科，无创通气用于急性慢性阻塞性肺疾病和充血性心力衰竭比用于急性哮喘更为常见。在急诊科更广泛使用无创通气的障碍包括医生的熟悉程度、急诊科呼吸治疗师和设备的可用性以及无创通气所需时间。对于急性哮喘，治疗益处的不确定性仍然是一个挑战。
