Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
Crit Care Med. 2012 Feb;40(2):455-60. doi: 10.1097/CCM.0b013e318232d75e.
Noninvasive positive pressure ventilation is beneficial for patients with acute respiratory failure. However, its possible benefit for patients with acute lung injury (200 mm Hg < PaO(2)/FIO(2) ≤300 mm Hg) remains unclear. Our aim was to assess the safety and efficacy of noninvasive positive pressure ventilation for patients with acute lung injury and compare this with high-concentration oxygen therapy.
A multicentered randomized controlled trial.
Ten multipurpose intensive care units.
Forty patients who fulfilled the criteria for acute lung injury were included in this study.
Patients were randomly allocated to receive either noninvasive positive pressure ventilation (noninvasive positive pressure ventilation group) or high-concentration oxygen therapy through a Venturi mask (control group).
Twenty-one patients were assigned to the noninvasive positive pressure ventilation group and 19 were in the control group. At study entry, the patients' characteristics in the two groups were similar. Noninvasive positive pressure ventilation application decreased the respiratory rate and improved PaO(2)/FIO(2) with time. The proportion of patients requiring intubation and the actual number of intubations in the noninvasive positive pressure ventilation group were significantly less than in the control group (one of 21 vs. seven of 19; p = .02, and one of 21 vs. four of 19; p = .04, respectively). Noninvasive positive pressure ventilation showed a trend for reducing inhospital mortality (one of 21 vs. five of 19; p = .09). The total number of organ failures in the noninvasive positive pressure ventilation group was significantly lower than in the control group (three vs. 14; p < .001).
Noninvasive positive pressure ventilation is safe for selected patients with acute lung injury. However, a larger randomized trial with need for intubation and mortality as the outcomes of interest is required.
无创正压通气对急性呼吸衰竭患者有益。然而，其对急性肺损伤（200mmHg＜PaO₂/FIO₂≤300mmHg）患者的可能益处尚不清楚。我们旨在评估无创正压通气对急性肺损伤患者的安全性和疗效，并将其与高浓度氧疗进行比较。
多中心随机对照试验。
10 个多用途重症监护病房。
符合急性肺损伤标准的 40 例患者纳入本研究。
患者随机分为接受无创正压通气（无创正压通气组）或文丘里面罩高浓度氧疗（对照组）。
21 例患者被分配至无创正压通气组，19 例患者入对照组。入组时，两组患者的特征相似。无创正压通气应用后，呼吸频率降低，PaO₂/FIO₂随时间改善。无创正压通气组需要插管的患者比例和实际插管数显著少于对照组（21 例中 1 例 vs. 19 例中 7 例；p=0.02，21 例中 1 例 vs. 19 例中 4 例；p=0.04）。无创正压通气组住院死亡率有降低趋势（21 例中 1 例 vs. 19 例中 5 例；p=0.09）。无创正压通气组器官衰竭总数显著低于对照组（3 例 vs. 14 例；p＜0.001）。
无创正压通气对急性肺损伤患者是安全的。然而，需要更大规模的随机试验，以插管和死亡率作为主要结局。
