Lopez-Campos Jose Luis, Jara-Palomares Luis, Muñoz Xavier, Bustamante Víctor, Barreiro Esther
Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla ; Centro de Investigación en Red de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.
Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla.
Ann Thorac Med. 2015 Apr-Jun;10(2):87-93. doi: 10.4103/1817-1737.151440.
Despite the overwhelming evidence justifying the use of non-invasive ventilation (NIV) for providing ventilatory support in chronic obstructive pulmonary disease (COPD) exacerbations, recent studies demonstrated that its application in real-life settings remains suboptimal. European clinical audits have shown that 1) NIV is not invariably available, 2) its availability depends on countries and hospital sizes, and 3) numerous centers declare their inability to provide NIV to all of the eligible patients presenting throughout the year. Even with an established indication, the use of NIV in acute respiratory failure due to COPD exacerbations faces important challenges. First, the location and personnel using NIV should be carefully selected. Second, the use of NIV is not straightforward despite the availability of technologically advanced ventilators. Third, NIV therapy of critically ill patients requires a thorough knowledge of both respiratory physiology and existing ventilatory devices. Accordingly, an optimal team-training experience, the careful selection of patients, and special attention to the selection of devices are critical for optimizing NIV outcomes. Additionally, when applied, NIV should be closely monitored, and endotracheal intubation should be promptly available in the case of failure. Another topic that merits careful consideration is the use of NIV in the elderly. This patient population is particularly fragile, with several physiological and social characteristics requiring specific attention in relation to NIV. Several other novel indications should also be critically examined, including the use of NIV during fiberoptic bronchoscopy or transesophageal echocardiography, as well as in interventional cardiology and pulmonology. The present narrative review aims to provide updated information on the use of NIV in acute settings to improve the clinical outcomes of patients hospitalized for COPD exacerbations.
尽管有大量证据支持在慢性阻塞性肺疾病（COPD）急性加重期使用无创通气（NIV）提供通气支持，但最近的研究表明，其在实际临床中的应用仍不理想。欧洲临床审计显示：1）NIV并非总是可用；2）其可用性因国家和医院规模而异；3）许多中心表示无法为全年所有符合条件的患者提供NIV。即使有明确的适应症，在COPD急性加重导致的急性呼吸衰竭中使用NIV仍面临重大挑战。首先，应仔细选择使用NIV的地点和人员。其次，尽管有技术先进的呼吸机，但NIV的使用并不简单。第三，对重症患者进行NIV治疗需要全面了解呼吸生理学和现有的通气设备。因此，优化团队培训经验、仔细选择患者以及特别关注设备选择对于优化NIV治疗效果至关重要。此外，应用NIV时应密切监测，若治疗失败应及时进行气管插管。另一个值得仔细考虑的问题是在老年人中使用NIV。这一患者群体特别脆弱，其一些生理和社会特征在NIV治疗方面需要特别关注。还应严格审查其他一些新的适应症，包括在纤维支气管镜检查或经食管超声心动图检查期间使用NIV，以及在介入心脏病学和肺病学中的应用。本叙述性综述旨在提供关于在急性情况下使用NIV的最新信息，以改善因COPD急性加重住院患者的临床结局。
