a Faculty of Health/School of Medicine, Cologne Merheim Hospital, Department of Pneumology , Kliniken der Stadt Köln; gGmbH Witten/Herdecke University , Germany.
COPD. 2017 Aug;14(4):389-395. doi: 10.1080/15412555.2017.1318843. Epub 2017 May 11.
High-intensity non-invasive positive pressure ventilation (NPPV) was originally described for chronic hypercapnic chronic obstructive pulmonary disease (COPD) patients in 2009, and refers to a specific ventilatory approach whereby NPPV settings are aimed at achieving the lowest arterial partial pressure of carbon dioxide (PaCO) values possible. Thus, high-intensity NPPV requires ventilator settings to be increased in a stepwise approach to either an individually tolerated maximum, or to the levels necessary to achieve normocapnia. This differs from the classic approach to low-intensity NPPV, which comprises considerably lower ventilator settings and typically fails to lower elevated PaCO values. The ongoing discussion about whether or not long-term NPPV should be used in chronic hypercapnic COPD patients is based on the observation that many studies in the last two decades have failed to provide evidence for this particular patient cohort. In addition, these trials preferably used low-intensity NPPV. There is now, however, increasing evidence to suggest that high-intensity NPPV is capable of improving important physiological parameters such as blood gases and lung function, as well as health-related quality of life. Moreover, this approach also produced positive outcomes following two recent randomized controlled trials, e.g., improved survival rates in stable COPD patients, and admission-free survival in patients with persisting hypercapnia following acute in-hospital NPPV to treat acute acidotic respiratory failure. As a consequence, the time has now come to evaluate the impact of long-term NPPV on both the physiological and clinical outcomes, with emphasis on the different approaches to NPPV. Therefore, the aim of the current review article is to elaborate on the clinical and physiological reasons for why high-intensity NPPV is favourable to low-intensity NPPV.
高流量无创正压通气（NPPV）最初于 2009 年被描述用于慢性高碳酸血症性慢性阻塞性肺疾病（COPD）患者，是指一种特定的通气方法，其中 NPPV 设置旨在实现尽可能低的动脉二氧化碳分压（PaCO）值。因此，高强度 NPPV 需要通过逐步增加呼吸机设置来实现，要么达到个体耐受的最大值，要么达到实现正常碳酸血症所需的水平。这与低强度 NPPV 的经典方法不同，低强度 NPPV 的呼吸机设置要低得多，通常无法降低升高的 PaCO 值。关于慢性高碳酸血症性 COPD 患者是否应长期使用 NPPV 的持续讨论是基于这样一个观察结果，即过去二十年的许多研究未能为这一特定患者群体提供证据。此外，这些试验优选使用低强度 NPPV。然而，现在有越来越多的证据表明，高强度 NPPV 能够改善重要的生理参数，如血气和肺功能，以及健康相关的生活质量。此外，这种方法还在最近的两项随机对照试验中产生了积极的结果，例如，稳定的 COPD 患者的生存率提高，以及在急性院内 NPPV 治疗急性酸中毒性呼吸衰竭后持续高碳酸血症的患者的无住院生存率提高。因此，现在是时候评估长期 NPPV 对生理和临床结果的影响了，重点是 NPPV 的不同方法。因此，本文的目的是阐述高强度 NPPV 优于低强度 NPPV 的临床和生理原因。
