Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France.
AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale du Département R3S, Paris, France.
Eur Respir Rev. 2019 Nov 6;28(154). doi: 10.1183/16000617.0043-2019. Print 2019 Dec 31.
Discharging a chronic critically ill patient is a risky procedure if the clinician does not have full control of his prescription. This is even more important when applying a machine to replace a failing organ, as is the case for home ventilation. Even if modern home ventilators fulfil quality and safety criteria and, 'on paper', ventilators and masks look very similar, performance and scenarios of applicability are not always equivalent. In the case of ventilators, the type of circuit, accessories provided and available modes vary between devices. Bench studies comparing ventilators have shown large differences in triggering, rise time, pressurisation capacities, maximal flow provided, cycling and level of authorised expiratory positive airway pressure. Automated algorithms to deal with leaks also vary and have not been sufficiently evaluated. In the case of interfaces, the choice of mask requires careful evaluation of the underlying disease and of the type of ventilator and circuit, which could have a potentially major impact on patient compliance and clinical effectiveness. This could explain different results in the same clinical situation. The choice of ventilator and type of mask represents a medical prescription and should be respected by the provider and not subject to financial constraints.
为慢性危重症患者办理出院手续是一项风险较大的操作，如果临床医生无法完全掌控其处方。当应用机器替代衰竭的器官时，情况更是如此，比如家庭通气。即使现代家用呼吸机满足质量和安全标准，并且“理论上”呼吸机和面罩看起来非常相似，但性能和适用场景并不总是等同的。对于呼吸机而言，其回路类型、提供的附件和可用模式在不同设备之间存在差异。对呼吸机进行的对比研究表明，触发、上升时间、加压能力、提供的最大流量、循环和允许的呼气正压水平存在很大差异。用于处理泄漏的自动化算法也存在差异，并且尚未得到充分评估。对于接口而言，面罩的选择需要仔细评估基础疾病以及呼吸机和回路的类型，这可能会对患者的依从性和临床疗效产生重大影响。这可以解释在相同临床情况下出现的不同结果。呼吸机的选择和面罩的类型代表了一种医疗处方，应由提供者尊重，而不应受到财务限制。
