Unit of Respiratory Physiopathology and Rehabilitation, A.O.R.N. "Dei Colli" - Monaldi Hospital, Naples, Italy.
Section of Respiratory Diseases, Department of Basic Medical Science Neuroscience and Sense Organs, Cardiothoracic Department, University of Bari 'Aldo Moro', Respiratory and Critical Care Unit, Bari Policlinic University Hospital, Bari, Italy.
Expert Rev Respir Med. 2023 Jan-Jun;17(6):517-525. doi: 10.1080/17476348.2023.2226391. Epub 2023 Jun 21.
Intermittent abdominal pressure ventilator (IAPV) use started in the 1930s for ventilatory assistance with muscular dystrophy patients. Later, the device was perfected and expanded for other neuromuscular disorders (NMD). In recent years, the morbidity and mortality tracheotomies and trach tubes related renewed the interest around IAPV. However, there are no guidelines for its use. This study aimed to establish a consensus among physicians involved in its practice to provide IAPV suggestions for the treatment of patients with NMD.
A 3-step modified Delphi method was used to establish consensus. Fourteen respiratory physicians and one psychiatrist with strong experience in IAPV use and/or who published manuscripts on the topic participated in the panel. A systematic review of the literature was carried out according to the PRISMA to identify existing evidence on IAPV for patients with neuromuscular disorders.
In the first round, 34 statements were circulated. Panel members marked 'agree' or 'disagree' for each statement and provided comments. The agreement was reached after the second voting session for all 34 statements.
Panel members agreed and IAPV indications, parameter settings (including procedure protocol), potential limitations, contraindications, complications, monitoring, and follow-up are described. This is the first expert consensus on IAPV.
间歇性腹部压力通气（IAPV）于 20 世纪 30 年代开始用于肌营养不良症患者的通气辅助。后来，该设备经过改进和扩展，用于治疗其他神经肌肉疾病（NMD）。近年来，与气管切开术和气管插管相关的发病率和死亡率使人们对 IAPV 的兴趣重新燃起。然而，目前尚无关于其使用的指南。本研究旨在汇集参与该实践的医生的共识，为 NMD 患者的治疗提供 IAPV 建议。
采用三步改良 Delphi 法建立共识。14 名呼吸科医生和 1 名精神病医生参加了小组讨论，他们在 IAPV 使用方面具有丰富的经验，或者发表过关于该主题的论文。根据 PRISMA 进行了系统的文献回顾，以确定现有关于神经肌肉疾病患者 IAPV 的证据。
在第一轮中，共提出了 34 项陈述。小组成员对每一项陈述进行“同意”或“不同意”的标记，并提供了评论。在第二轮投票后，所有 34 项陈述均达成一致。
小组成员一致认为，IAPV 的适应证、参数设置（包括程序方案）、潜在局限性、禁忌证、并发症、监测和随访都得到了描述。这是关于 IAPV 的第一个专家共识。
