Barbas Carmen Sílvia Valente, Serpa Neto Ary
1 Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil ; 2 Pulmonary Division, Heart Institute and Hospital das Clinicas of University of São Paulo Medical School, São Paulo, Brazil ; 3 Program of Post-Graduation, Research and Innovation, Faculdade de Medicina do ABC, São Paulo, Brazil ; 4 Department of Intensive Care, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
J Thorac Dis. 2016 Jan;8(1):E100-3. doi: 10.3978/j.issn.2072-1439.2016.01.30.
On October 27, 2015, Lemile and colleagues published an article in JAMA entitled "Effect of Noninvasive Ventilation vs. Oxygen Therapy on Mortality among Immunocompromised Patients with Acute Respiratory Failure: A Randomized Clinical Trial", which investigated the effects of non-invasive ventilation (NIV) in 28-day mortality of 374 critically ill immunosuppressed patients. The authors found that among immunosuppressed patients admitted to the intensive care unit (ICU) with hypoxemic acute respiratory failure, early NIV compared with oxygen therapy alone did not reduce 28-day mortality. Furthermore, different from the previous publications, there were no significant differences in ICU-acquired infections, duration of mechanical ventilation, or lengths of ICU or hospital stays. The study power was limited, median oxygen flow used was higher than used before or 9 L/min, NIV settings provided tidal volumes higher than what is considered protective nowadays or from 7 to 10 mL/kg of ideal body weight and the hypoxemic respiratory failure was moderate to severe (median PaO2/FIO2 was around 140), a group prone to failure in noninvasive ventilatory support. Doubts arose regarding the early use of NIV in immunosuppressed critically ill patients with non-hypercapnic hypoxemic respiratory failure that need to be solved in the near future.
2015年10月27日，勒米尔及其同事在《美国医学会杂志》上发表了一篇题为《无创通气与氧疗对免疫功能低下的急性呼吸衰竭患者死亡率的影响：一项随机临床试验》的文章，该研究调查了无创通气（NIV）对374例重症免疫抑制患者28天死亡率的影响。作者发现，在因低氧性急性呼吸衰竭入住重症监护病房（ICU）的免疫抑制患者中，与单纯氧疗相比，早期使用无创通气并不能降低28天死亡率。此外，与之前的研究结果不同，在ICU获得性感染、机械通气时间、ICU住院时间或住院总时长方面并无显著差异。该研究的检验效能有限，所使用的中位氧流量高于以往或9升/分钟，无创通气设置提供的潮气量高于目前认为的保护性潮气量，即理想体重7至10毫升/千克，且低氧性呼吸衰竭为中重度（中位动脉血氧分压/吸入氧浓度约为140），这是一组无创通气支持容易失败的患者。对于在无高碳酸血症的低氧性呼吸衰竭的免疫抑制重症患者中早期使用无创通气产生了疑问，这些疑问需要在不久的将来得到解决。
