Department of Physical Medicine and Rehabilitation, Rutgers University - New Jersey Medical School, United States.
Department of Physical Medicine and Rehabilitation, Rutgers University - New Jersey Medical School, United States.
Pulmonology. 2021 Sep-Oct;27(5):386-393. doi: 10.1016/j.pulmoe.2020.12.003. Epub 2021 Jan 11.
In the conventional management of the morbidly obese that normalizes the apnea-hypopnea index (AHI), CO2 levels often remain elevated.
A retrospective review of morbidly obese patients using volume preset settings up to 1800ml to positive inspiratory pressures (PIPs) of 25-55cm H2O, or pressure control at 25-50cm H2O pressure via noninvasive interfaces up to continuously (CNVS).
Twenty-six patients, mean 55.6±14.8 years of age, weight 108-229kg, mean BMI 56.1 (35.5-77)kg/m, mean AHI 69.0±24.9, depended on up to CNVS for 3 weeks to up to 66 years. There were eleven extubations and seven decannulations to CNVS despite failure to pass spontaneous breathing trials. Thirteen were CNVS dependent for 92.2 patient-years with little to no ventilator free breathing ability (VFBA). Six used NVS from 10 to 23h a day, and others only for sleep. Fifteen patients with cough peak flows (CPF) less than 270L/m had access to mechanical insufflation-exsufflation (MIE) in the peri-extubation/decannulation period and long-term. The daytime end-tidal (Et)CO2 of 14 who were placed on sleep NVS without extubation or decannulation to it decreased from mean EtCO2 61.0±9.3-38.5±3.6mm Hg and AHI normalized to 2.2. Blood gas levels were normal while using NVS/CNVS. Pre-intubation PaCO2 levels, when measured, were as high as 183mm Hg before extubation to CNVS.
Ventilator unweanable morbidly obese patients can be safely extubated/decannulated and maintained indefinitely using up to CNVS rather than resort to tracheotomies.
在病态肥胖的常规管理中，通过使呼吸暂停低通气指数（AHI）正常化，二氧化碳水平往往仍然升高。
对使用体积预设设置高达 1800ml 的病态肥胖患者进行回顾性审查，吸气压力（PIP）为 25-55cm H2O，或通过非侵入性接口以 25-50cm H2O 压力进行压力控制，持续至（CNVS）。
26 例患者，平均年龄 55.6±14.8 岁，体重 108-229kg，平均 BMI 56.1（35.5-77）kg/m，平均 AHI 69.0±24.9，依靠 CNVS 进行 3 周至 66 年。尽管未能通过自主呼吸试验，但有 11 例拔管和 7 例气切至 CNVS。13 例患者依赖 CNVS 92.2 患者年，几乎没有呼吸机自由呼吸能力（VFBA）。6 例患者每天使用 NVS 10-23 小时，其他人仅用于睡眠。15 例咳嗽峰流速（CPF）小于 270L/m 的患者在拔管/气切期间和长期使用机械通气-呼气（MIE）。14 名白天无插管或气切至睡眠 NVS 的患者 ETCO2 从平均 ETCO2 61.0±9.3-38.5±3.6mmHg 下降，AHI 正常化至 2.2。使用 NVS/CNVS 时血气水平正常。在使用 NVS/CNVS 时，测量到的预插管 PaCO2 水平在拔管至 CNVS 时高达 183mmHg。
病态肥胖患者无法脱机的呼吸机患者可以安全地拔管/气切，并使用 CNVS 无限期维持，而无需进行气管切开术。
