aLane Fox Respiratory Unit, Guy's and St. Thomas' NHS Foundation Trust, UK bGuy's and St Thomas' NHS Foundation Trust and King's College London, National Institute for Health Research Comprehensive Biomedical Research Centre cDivision of Asthma, Allergy and Lung Biology, King's College London, London, UK.
Curr Opin Pulm Med. 2013 Nov;19(6):626-30. doi: 10.1097/MCP.0b013e3283659e4c.
This review examines the current reports, the evidence and the issues surrounding the use of non-invasive ventilation (NIV) for the treatment of chronic obstructive pulmonary disease (COPD) in both the acute and domiciliary setting.
With the increasing use of NIV, more recent studies have focused on investigating the outcomes of our current practice. Although overall morbidity and mortality outcomes in the acute setting have improved, patients who initially stabilize but then deteriorate during an acute exacerbation of COPD have a poor prognosis. The focus must be on phenotyping this high-risk group to investigate other potential rescue treatments, including extracorporeal carbon dioxide removal. Indeed, phenotyping appears to favour the obese COPD patient, which may have a protective role in reducing the risk of NIV failure and recurrent hospital admissions. Randomized controlled trial evidence to support the use of NIV in a domiciliary setting as a treatment for COPD is awaited, and until the data from a number of ongoing clinical trials are available, the wide variation in global practice will continue. Increased understanding of patient ventilator asynchrony has improved domiciliary NIV set up, which is expected to enhance the tolerability of NIV, promoting patient adherence.
NIV is the established standard of care to treat acute hypercapnic exacerbations of COPD postoptimal medical management. NIV as a long-term treatment for COPD remains controversial based on the evidence from the published randomized controlled trials. With increasing experience of NIV therapy, patient outcomes are improving; however, further work is still required to better characterize and target the patients who will most benefit from NIV.
本文回顾了目前关于无创通气（NIV）在急性和家庭环境中治疗慢性阻塞性肺疾病（COPD）的报告、证据和问题。
随着 NIV 使用的增加，最近的研究集中在调查我们当前实践的结果。尽管急性环境中的整体发病率和死亡率有所改善，但在 COPD 急性加重期间最初稳定但随后恶化的患者预后较差。重点必须放在对这一高风险人群进行表型分析上，以研究其他潜在的抢救治疗方法，包括体外二氧化碳去除。事实上，表型分析似乎有利于肥胖 COPD 患者，这可能在降低 NIV 失败和反复住院的风险方面发挥保护作用。支持将 NIV 作为 COPD 的家庭治疗方法的随机对照试验证据仍在等待，并且在许多正在进行的临床试验数据可用之前，全球实践中的广泛差异将继续存在。对患者通气不同步的认识增加了家庭 NIV 设置，这有望提高 NIV 的耐受性，促进患者的依从性。
NIV 是治疗最佳药物治疗后急性高碳酸血症性 COPD 加重的既定标准护理。基于已发表的随机对照试验的证据，NIV 作为 COPD 的长期治疗仍存在争议。随着 NIV 治疗经验的增加，患者的预后正在改善；然而，仍需要进一步的工作来更好地描述和针对最受益于 NIV 的患者。
