Gifford Alex H
Pulmonary and Critical Care Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
Curr Opin Support Palliat Care. 2014 Sep;8(3):218-24. doi: 10.1097/SPC.0000000000000068.
Dyspnea is a distressing consequence of many unremitting diseases. This review discusses the therapeutic use of noninvasive ventilation (NIV) in advanced illness.
NIV continues to be investigated most rigorously in patients with progressive neuromuscular weakness and the combination of emphysema and lung cancer. Data are quite limited on the palliative role of NIV in bronchiectasis and interstitial lung diseases. It remains difficult to identify the subsets of patients with acute-on-chronic respiratory failure who are most likely to benefit from ICU admission, but NIV may particularly help those with hypercapnia. The question of whether general or disease-specific instruments should be used to evaluate the effects of NIV on quality of life is unanswered. Computerized decision aids have been developed to assist providers, patients, and their families with advance care planning.
NIV is an important adjunct to medications for patients with intractable dyspnea. Future research should attempt to clarify the effectiveness of NIV at controlling dyspnea within and outside the hospital. Barriers to its domiciliary application are largely unknown. Processes should be developed to optimize communication among clinicians, patients, and their caregivers around the issues of when to start NIV and how to withdraw it at the end of life.
呼吸困难是许多难治性疾病令人痛苦的后果。本综述讨论无创通气（NIV）在晚期疾病中的治疗应用。
在进行性神经肌肉无力以及肺气肿合并肺癌患者中，对NIV的研究最为严格。关于NIV在支气管扩张症和间质性肺疾病中的姑息作用的数据相当有限。仍然难以确定哪些慢性呼吸衰竭急性加重患者最有可能从入住重症监护病房中获益，但NIV可能对高碳酸血症患者特别有帮助。对于应使用通用还是疾病特异性工具来评估NIV对生活质量的影响这一问题，尚无答案。已开发出计算机化决策辅助工具，以协助医疗服务提供者、患者及其家属进行预先护理规划。
对于难治性呼吸困难患者，NIV是药物治疗的重要辅助手段。未来的研究应试图阐明NIV在医院内外控制呼吸困难的有效性。其家庭应用的障碍在很大程度上尚不清楚。应制定相关流程，以优化临床医生、患者及其护理人员之间围绕何时开始使用NIV以及在生命终末期如何撤机等问题的沟通。
