Respiratory Care Services, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
Respir Care. 2012 Oct;57(10):1619-25. doi: 10.4187/respcare.01943.
In recent years, there has been increasing interest in the use of noninvasive ventilation (NIV) in the post-extubation period to shorten the length of invasive ventilation, to prevent extubation failure, and to rescue a failed extubation. The purpose of this review is to summarize the evidence related to the use of NIV in these settings. NIV can be used to allow earlier extubation in selected patients who do not successfully complete a spontaneous breathing trial (SBT). Its use in this setting should be restricted to patients who are intubated during an exacerbation of COPD or patients with neuromuscular disease. This category of patients should be good candidates for NIV and should be extubated directly to NIV. In patients who successfully complete an SBT, but are at risk for extubation failure, NIV can be used to prevent extubation failure. These patients should also be good candidates for NIV and should be extubated directly to NIV. NIV should be used cautiously in patients who successfully complete an SBT, but develop respiratory failure within 48 hours post-extubation. In this setting, NIV is indicated only in patients with hypercapnic respiratory failure. Reintubation should not be delayed if NIV is not immediately successful in reversing the post-extubation respiratory failure. Evidence does not support routine use of NIV post-extubation.
近年来，人们对在拔管后使用无创通气（NIV）越来越感兴趣，目的是缩短有创通气的时间，预防拔管失败，并抢救拔管失败的患者。本文综述了与这些情况下使用 NIV 相关的证据。NIV 可用于允许在未成功完成自主呼吸试验（SBT）的特定患者中更早地拔管。在这种情况下，应将其仅用于在 COPD 加重或神经肌肉疾病期间插管的患者。这类患者应是 NIV 的良好候选者，并应直接拔管至 NIV。对于成功完成 SBT 但有拔管失败风险的患者，NIV 可用于预防拔管失败。这些患者也应是 NIV 的良好候选者，并应直接拔管至 NIV。对于成功完成 SBT 但在拔管后 48 小时内发生呼吸衰竭的患者，应谨慎使用 NIV。在此情况下，NIV 仅适用于有高碳酸血症性呼吸衰竭的患者。如果 NIV 不能立即成功逆转拔管后的呼吸衰竭，不应延迟重新插管。证据不支持常规在拔管后使用 NIV。
