Banfi Paolo I, Volpato Eleonora, Bach John R
IRCCS Santa Maria Nascente, Fondazione Don Carlo Gnocchi, Milan, Italy.
2Department of Psychology, Università Cattolica del Sacro Cuore, Milan, Italy.
Multidiscip Respir Med. 2019 Jan 28;14:4. doi: 10.1186/s40248-019-0169-4. eCollection 2019.
Non-invasive ventilation (NIV) is the treatment of choice for patients symptomatic for respiratory muscle dysfunction. It can normalize gas exchange and provide up to continuous non-invasive ventilator support (CNVS) as an alternative to intubation and tracheotomy. It is usually provided via non-invasive facial interfaces or mouthpieces, but these can be uncomfortable and uncosmetic. The intermittent abdominal pressure ventilator (IAPV) has been used for diurnal ventilatory support since 1938 but has been off the market since about 1990. Now, however, with greater emphasis on non-invasive management, a new IAPV is available. A patient with chronic ventilatory insufficiency post-ischemic cervical myelopathy, dependent on sleep NVS since 2003, developed symptomatic daytime hypercapnia for which he also used diurnal NVS via nasal pillows. However, he preferred not having to use facial interfaces. When not using diurnal NVS he was becoming dyspnoeic. Diurnal use of an IAPV was introduced. Arterial blood gas analysis using the IAPV decreased his blood pH from 7.45 to 7.42, PaCO from 58 to 37 mmHg, and improved PaO from 62 to 92 mmHg. At discharge, the patient used the IAPV 8 h/day with improved mood and quality of life. Consequently, he returned to work as a painter.
无创通气（NIV）是有呼吸肌功能障碍症状患者的首选治疗方法。它可使气体交换正常化，并提供持续无创通气支持（CNVS）作为插管和气管切开的替代方案。通常通过无创面部接口或口含器提供，但这些可能会让人感到不适且不美观。间歇性腹部压力呼吸机（IAPV）自1938年以来一直用于日间通气支持，但自1990年左右已退出市场。然而，现在随着对无创管理的更加强调，一种新的IAPV可供使用。一名患有缺血性颈髓病后慢性通气不足的患者，自2003年以来依赖睡眠无创通气，出现了有症状的日间高碳酸血症，为此他也通过鼻枕使用日间无创通气。然而，他不愿意使用面部接口。不使用日间无创通气时，他会出现呼吸困难。于是引入了日间使用IAPV。使用IAPV进行动脉血气分析后，他的血液pH值从7.45降至7.42，动脉血二氧化碳分压（PaCO）从58降至37mmHg，动脉血氧分压（PaO）从62升至92mmHg。出院时，患者每天使用IAPV 8小时，情绪和生活质量得到改善。因此，他重返画家岗位工作。
