Duiverman Marieke L, Windisch Wolfram, Storre Jan H, Wijkstra Peter J
University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen 9700 RB, the Netherlands
Lungenklinik Merheim, Kliniken der Stadt Köln GmbH, Köln, Universität Witten/Herdecke, Germany.
Ther Adv Respir Dis. 2016 Apr;10(2):149-57. doi: 10.1177/1753465815624645. Epub 2016 Jan 8.
Recently, clear benefits have been shown from long-term noninvasive ventilation (NIV) in stable chronic obstructive pulmonary disease (COPD) patients with chronic hypercapnic respiratory failure. In our opinion, these benefits are confirmed and nocturnal NIV using sufficiently high inspiratory pressures should be considered in COPD patients with chronic hypercapnic respiratory failure in stable disease, preferably combined with pulmonary rehabilitation. In contrast, clear benefits from (continuing) NIV at home after an exacerbation in patients who remain hypercapnic have not been shown. In this review we will discuss the results of five trials investigating the use of home nocturnal NIV in patients with prolonged hypercapnia after a COPD exacerbation with acute hypercapnic respiratory failure. Although some uncontrolled trials might have shown some benefits of this therapy, the largest randomized controlled trial did not show benefits in terms of hospital readmission or death. However, further studies are necessary to select the patients that optimally benefit, select the right moment to initiate home NIV, select the optimal ventilatory settings, and to choose optimal follow up programmes. Furthermore, there is insufficient knowledge about the optimal ventilatory settings in the post-exacerbation period. Finally, we are not well informed about exact reasons for readmission in patients on NIV, the course of the exacerbation and the treatment instituted. A careful follow up might probably be necessary to prevent deterioration on NIV early.
最近，长期无创通气（NIV）已被证明对患有慢性高碳酸血症呼吸衰竭的稳定期慢性阻塞性肺疾病（COPD）患者有明显益处。我们认为，这些益处是确凿的，对于病情稳定的慢性高碳酸血症呼吸衰竭的COPD患者，应考虑使用足够高吸气压力的夜间NIV，最好结合肺康复治疗。相比之下，对于仍有高碳酸血症的患者，在急性加重后在家中（持续）使用NIV的明显益处尚未得到证实。在这篇综述中，我们将讨论五项试验的结果，这些试验研究了在COPD急性加重伴急性高碳酸血症呼吸衰竭后出现长期高碳酸血症的患者中使用家庭夜间NIV的情况。尽管一些非对照试验可能显示了这种治疗的一些益处，但最大的随机对照试验并未显示在再次入院或死亡方面有任何益处。然而，有必要进行进一步研究，以选择最能从中受益的患者，选择开始家庭NIV的合适时机，选择最佳通气设置，并选择最佳随访方案。此外，对于急性加重期后的最佳通气设置，我们了解不足。最后，我们对接受NIV治疗的患者再次入院的确切原因、急性加重的过程及所采取的治疗方法了解不够。可能需要进行仔细的随访，以早期预防NIV治疗时病情恶化。
