Bach John R, Pham Hoa
From the Department of Physical Medicine and Rehabilitation, Rutgers University-New Jersey Medical School, Newark, New Jersey (JRB); Center for Ventilator Management Alternatives, University Hospital of Newark, Newark, New Jersey (JRB); and Rutgers University-New Jersey Medical School, Newark, New Jersey (HP).
Am J Phys Med Rehabil. 2022 Apr 1;101(4):400-404. doi: 10.1097/PHM.0000000000001905.
Many studies suggest a brief statistical benefit on survival and quality of life by using nasal noninvasive ventilation for patients with amyotrophic lateral sclerosis and other neuromuscular conditions. Indeed, nasal noninvasive ventilation has become synonymous with continuous positive airway pressure and lo-span bilevel positive airway pressure. Nasal noninvasive ventilation, however, may not normalize CO2 levels and continuous positive airway pressure and O2 exacerbate hypercapnia and often lead to CO2 narcosis, intubation, and ultimately tracheostomy or palliative care death. However, a third option can be to offer up to continuous noninvasive ventilatory support and extubation to it. Noninvasive ventilatory support can be effective for full, definitive ventilatory support, even for people with no measurable vital capacity, and has maintained classic amyotrophic lateral sclerosis patients for up to 12 yrs without resort to tracheotomies. Nineteen centers have reported 335 amyotrophic lateral sclerosis patients using continuous noninvasive ventilatory support instead of tracheostomy mechanical ventilation for an average of 14 mos (6 mos to 14 yrs). The noninvasive ventilatory support must also be used in conjunction with mechanical insufflation-exsufflation to clear airway debris and normalize or renormalize ambient air oxyhemoglobin saturation, both to avoid intubation and to facilitate extubation. People with amyotrophic lateral sclerosis satisfying specific criteria, even when continuously dependent on tracheostomy mechanical ventilation, can be decannulated and placed on continuous noninvasive ventilatory support with mechanical insufflation-exsufflation.
许多研究表明，对于肌萎缩侧索硬化症和其他神经肌肉疾病患者，使用鼻无创通气在生存和生活质量方面有短暂的统计学益处。事实上，鼻无创通气已成为持续气道正压通气和低水平双水平气道正压通气的代名词。然而，鼻无创通气可能无法使二氧化碳水平正常化，持续气道正压通气和吸氧会加重高碳酸血症，并常常导致二氧化碳麻醉、插管，最终导致气管切开或姑息治疗死亡。然而，第三种选择可以是提供持续的无创通气支持并对其进行拔管。无创通气支持对于全面、确定性的通气支持可能是有效的，即使对于没有可测量肺活量的人也是如此，并且已使典型的肌萎缩侧索硬化症患者在不进行气管切开的情况下维持长达12年。19个中心报告了335例肌萎缩侧索硬化症患者使用持续无创通气支持而非气管切开机械通气，平均时间为14个月（6个月至14年）。无创通气支持还必须与机械吸气-呼气相结合，以清除气道内的分泌物，并使周围空气氧合血红蛋白饱和度正常化或恢复正常，以避免插管并便于拔管。符合特定标准的肌萎缩侧索硬化症患者，即使持续依赖气管切开机械通气，也可以拔除气管套管，并接受持续无创通气支持及机械吸气-呼气。
