Hess Dean R
Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Respir Care. 2011 Feb;56(2):153-65; discussion 165-7. doi: 10.4187/respcare.01049.
There is arguably more evidence to support the use of noninvasive ventilation (NIV) than any other practice related to the care of patients with acute respiratory failure. Despite this strong evidence base, NIV seems to be under-utilized and the failure rate (need for intubation) may be as high as 40%. Some of these failures potentially relate to asynchrony, although the relationship between asynchrony and NIV failure has not been well studied. Good NIV tolerance has been associated with success of NIV, and improved comfort has been associated with better synchrony. In one study a high rate of asynchrony occurred in 43% of patients during NIV. Asynchrony is commonly associated with leaks. Thus, reducing the leak related to the interface and using a ventilator with good leak compensation should reduce the rate of asynchrony. Asynchronies can also be related to the underlying disease process. This paper reviews issues related to asynchrony during NIV and suggests strategies that might be used to correct asynchrony when it occurs.
与急性呼吸衰竭患者护理的其他任何措施相比，有更多证据支持使用无创通气（NIV）。尽管有如此坚实的证据基础，但NIV似乎未得到充分利用，失败率（需要插管）可能高达40%。其中一些失败可能与不同步有关，尽管不同步与NIV失败之间的关系尚未得到充分研究。良好的NIV耐受性与NIV的成功相关，而舒适度的提高与更好的同步性相关。在一项研究中，43%的患者在NIV期间出现了高比例的不同步。不同步通常与漏气有关。因此，减少与接口相关的漏气并使用具有良好漏气补偿功能的呼吸机应可降低不同步率。不同步也可能与潜在的疾病过程有关。本文综述了与NIV期间不同步相关的问题，并提出了在出现不同步时可能用于纠正不同步的策略。
