Nicolini Antonello, Lemyze Malcom, Esquinas Antonio, Barlascini Cornelius, Cavalleri Maurizio A
Department of Respiratory and Critical Care Medicine, Schaffner Hospital, lens; Intensive Care Unit Hospital Morales Meseguer, Murcia; Internal Medicine Department, via Terzi 43, Sestri Levante.
Adv Respir Med. 2017;85(5):264-270. doi: 10.5603/ARM.a2017.0044. Epub 2017 Oct 30.
Non-invasive ventilation ( NIV ) has been used successfully for the management of acute respiratory failure (ARF) more often in the last two decades than previously. Unfortunately, NIV can have failure rates ranging from 5% to 50% and patient selection is the key to success. There are particular groups of patients that are more likely to benefit from NIV. For patients with hypoventilation syndrome (OHS) this treatment can be beneficial. This review seeks to evaluate the effectiveness of NIV in acute ARF and determine predictors of NIV failure in morbidly obese patients. Only a few studies have investigated NIV success or failure in these patients. NIV was most often effective when patients were carefully selected. Obese patients who exhibited early NIV failure had a high severity score at admission. In contrast, more than half of hypercapnic patients with decompensated OHS exhibited a delayed but successful response to NIV. Patients with decompensation of OHS had better prognosis and response to NIV than other hypercapnic patients. They required more aggressive NIV settings, a longer time to reduce paCO₂ levels , and more frequently a delayed but successful response to NIV which should encourage the use of NIV rather than early intubation. Since clear predictors of NIV failure have not been identified, a strict and prolonged monitoring is mandatory.
在过去二十年中，无创通气（NIV）比以往更常用于急性呼吸衰竭（ARF）的治疗，且取得了成功。不幸的是，NIV的失败率在5%至50%之间，而患者的选择是成功的关键。有特定的患者群体更有可能从NIV中获益。对于低通气综合征（OHS）患者，这种治疗可能有益。本综述旨在评估NIV在急性ARF中的有效性，并确定病态肥胖患者NIV失败的预测因素。只有少数研究调查了这些患者中NIV的成功或失败情况。当患者经过精心挑选时，NIV通常最有效。早期出现NIV失败的肥胖患者入院时严重程度评分较高。相比之下，超过一半的失代偿性OHS高碳酸血症患者对NIV表现出延迟但成功的反应。与其他高碳酸血症患者相比，OHS失代偿患者对NIV的预后和反应更好。他们需要更积极的NIV设置、更长的时间来降低动脉血二氧化碳分压（PaCO₂）水平，并且更频繁地对NIV表现出延迟但成功的反应，这应该鼓励使用NIV而非早期插管。由于尚未确定NIV失败的明确预测因素，因此必须进行严格且长时间的监测。
