Univ Lille Nord de France, UDSL, EA 2694, F-59000 Lille, France.
Ann Intensive Care. 2011 May 26;1(1):15. doi: 10.1186/2110-5820-1-15.
Noninvasive positive pressure ventilation (NPPV) refers to the delivery of mechanical respiratory support without the use of endotracheal intubation (ETI). The present review focused on the effectiveness of NPPV in children > 1 month of age with acute respiratory failure (ARF) due to different conditions. ARF is the most common cause of cardiac arrest in children. Therefore, prompt recognition and treatment of pediatric patients with pending respiratory failure can be lifesaving. Mechanical respiratory support is a critical intervention in many cases of ARF. In recent years, NPPV has been proposed as a valuable alternative to invasive mechanical ventilation (IMV) in this acute setting. Recent physiological studies have demonstrated beneficial effects of NPPV in children with ARF. Several pediatric clinical studies, the majority of which were noncontrolled or case series and of small size, have suggested the effectiveness of NPPV in the treatment of ARF due to acute airway (upper or lower) obstruction or certain primary parenchymal lung disease, and in specific circumstances, such as postoperative or postextubation ARF, immunocompromised patients with ARF, or as a means to facilitate extubation. NPPV was well tolerated with rare major complications and was associated with improved gas exchange, decreased work of breathing, and ETI avoidance in 22-100% of patients. High FiO2 needs or high PaCO2 level on admission or within the first hours after starting NPPV appeared to be the best independent predictive factors for the NPPV failure in children with ARF. However, many important issues, such as the identification of the patient, the right time for NPPV application, and the appropriate setting, are still lacking. Further randomized, controlled trials that address these issues in children with ARF are recommended.
无创正压通气（NPPV）是指在不使用气管插管（ETI）的情况下提供机械呼吸支持。本综述重点关注 NPPV 在因不同情况导致急性呼吸衰竭（ARF）的>1 个月大的儿童中的有效性。ARF 是儿童心脏骤停最常见的原因。因此，及时识别和治疗有潜在呼吸衰竭的儿科患者可以挽救生命。机械呼吸支持是许多 ARF 病例的关键干预措施。近年来，NPPV 已被提议作为这种急性情况下有创机械通气（IMV）的有价值替代方法。最近的生理学研究表明，NPPV 对 ARF 儿童有益。一些儿科临床研究，其中大多数是非对照或病例系列研究且规模较小，表明 NPPV 在治疗急性气道（上或下）阻塞或某些原发性肺实质疾病引起的 ARF 以及在特定情况下（如术后或拔管后 ARF、免疫功能低下的 ARF 患者）有效，或作为促进拔管的手段。NPPV 耐受性良好，罕见严重并发症，在 22-100%的患者中改善气体交换、降低呼吸功和避免 ETI。高 FiO2 需要或开始 NPPV 后最初几小时内的高 PaCO2 水平似乎是 ARF 儿童 NPPV 失败的最佳独立预测因素。然而，许多重要问题，例如患者的识别、NPPV 应用的正确时间和适当的设置，仍然存在。建议在 ARF 儿童中进行进一步的随机、对照试验，以解决这些问题。
