Department of Anesthesia and Intensive Care Medicine, San Giovanni Battista-Molinette Hospital, University of Turin, Italy.
Minerva Anestesiol. 2011 Sep;77(9):921-6.
Noninvasive ventilation (NIV) has gained increasing acceptance over the years to reduce endotracheal intubation, pneumonia and to prevent or treat respiratory failure in patients with different diagnoses. The international consensus conference, and the British society guidelines on NIV ventilation have analyzed its use during the weaning phase concluding that there were still conflicting results of its use. However, recent clinical trials have shown clear clinical benefits on the use of NIV in several patient populations during the weaning period. Acute respiratory failure (ARF) during the weaning process is the main object of recently published studies. The latest published randomized trials on the application of NIV for acute respiratory failure following extubation failed to demonstrate any favorable outcome. Even so, the use of NIV during the process of weaning in patients experiencing multiple weaning failure or as a preventive therapy in patients at higher risk of respiratory deterioration showed improved clinical outcomes only in chronic obstructive pulmonary disease and in particular in hypercapnic patients. Reduced invasive mechanical ventilation, tracheostomy and lower mortality rate at 90 days were the major advantages.
多年来，无创通气（NIV）越来越被接受，以减少气管插管、肺炎，并预防或治疗不同诊断的患者的呼吸衰竭。国际共识会议和英国 NIV 通气指南分析了其在脱机阶段的使用，得出的结论是其使用仍存在矛盾的结果。然而，最近的临床试验显示，在脱机期间，NIV 在几个患者群体中的使用具有明显的临床益处。急性呼吸衰竭（ARF）是最近发表的研究的主要对象。最近发表的关于拔管后急性呼吸衰竭应用 NIV 的随机试验未能证明任何有利的结果。即便如此，在经历多次脱机失败的患者或在有更高呼吸恶化风险的患者中，将 NIV 用于脱机过程作为预防性治疗，仅在慢性阻塞性肺疾病患者中，特别是在高碳酸血症患者中，显示出改善的临床结局。降低有创机械通气、气管切开术和 90 天死亡率是主要优势。
