关于危重症患者无创通气的十篇重要文章及未来展望：专家意见报告
Ten important articles on noninvasive ventilation in critically ill patients and insights for the future: A report of expert opinions.
作者信息
Cortegiani A, Russotto V, Antonelli M, Azoulay E, Carlucci A, Conti G, Demoule A, Ferrer M, Hill N S, Jaber S, Navalesi P, Pelosi P, Scala R, Gregoretti C
机构信息
Department of Biopathology and Medical Biotechnologies (DIBIMED). Section of Anestesia, Analgesia, Intensive Care and Emergency, Policlinico P. Giaccone, University of Palermo, Palermo, Italy.
Department of Intensive Care and Anaesthesia, Policlinico A. Gemelli, Catholic University of Rome, Rome, Italy.
出版信息
BMC Anesthesiol. 2017 Sep 4;17(1):122. doi: 10.1186/s12871-017-0409-0.
BACKGROUND
Noninvasive ventilation is used worldwide in many settings. Its effectiveness has been proven for common clinical conditions in critical care such as cardiogenic pulmonary edema and chronic obstructive pulmonary disease exacerbations. Since the first pioneering studies of noninvasive ventilation in critical care in the late 1980s, thousands of studies and articles have been published on this topic. Interestingly, some aspects remain controversial (e.g. its use in de-novo hypoxemic respiratory failure, role of sedation, self-induced lung injury). Moreover, the role of NIV has recently been questioned and reconsidered in light of the recent reports of new techniques such as high-flow oxygen nasal therapy.
METHODS
We conducted a survey among leading experts on NIV aiming to 1) identify a selection of 10 important articles on NIV in the critical care setting 2) summarize the reasons for the selection of each study 3) offer insights on the future for both clinical application and research on NIV.
RESULTS
The experts selected articles over a span of 26 years, more clustered in the last 15 years. The most voted article studied the role of NIV in acute exacerbation chronic pulmonary disease. Concerning the future of clinical applications for and research on NIV, most of the experts forecast the development of innovative new interfaces more adaptable to patients characteristics, the need for good well-designed large randomized controlled trials of NIV in acute "de novo" hypoxemic respiratory failure (including its comparison with high-flow oxygen nasal therapy) and the development of software-based NIV settings to enhance patient-ventilator synchrony.
CONCLUSIONS
The selection made by the experts suggests that some applications of NIV in critical care are supported by solid data (e.g. COPD exacerbation) while others are still waiting for confirmation. Moreover, the identified insights for the future would lead to improved clinical effectiveness, new comparisons and evaluation of its role in still "lack of full evidence" clinical settings.
背景
无创通气在全球许多情况下都有应用。其有效性已在重症监护的常见临床病症中得到证实，如心源性肺水肿和慢性阻塞性肺疾病急性加重。自20世纪80年代末在重症监护中首次开展无创通气的开创性研究以来，关于这一主题已发表了数千项研究和文章。有趣的是，有些方面仍存在争议（例如其在新发低氧性呼吸衰竭中的应用、镇静的作用、自身诱导性肺损伤）。此外，鉴于最近高流量鼻导管吸氧等新技术的报道，无创通气的作用最近受到了质疑和重新审视。
方法
我们对无创通气领域的顶尖专家进行了一项调查，旨在1）挑选出10篇关于重症监护中无创通气的重要文章2）总结每项研究入选的原因3）对无创通气的临床应用和研究未来提供见解。
结果
专家们挑选的文章跨越了26年，更多集中在过去15年。得票最多的文章研究了无创通气在慢性肺疾病急性加重中的作用。关于无创通气的临床应用和研究未来，大多数专家预测会开发出更适合患者特点的创新型新界面，需要针对急性“新发”低氧性呼吸衰竭开展精心设计的大型无创通气随机对照试验（包括与高流量鼻导管吸氧进行比较），以及开发基于软件的无创通气设置以增强患者与呼吸机的同步性。
结论
专家们的挑选表明，无创通气在重症监护中的一些应用有确凿数据支持（如慢性阻塞性肺疾病急性加重），而其他一些应用仍有待证实。此外，确定的未来见解将提高临床有效性，对其在仍“缺乏充分证据”的临床环境中的作用进行新的比较和评估。
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