Zha S S, He Z F, Guan L L, Niu J Y, Huang Q Y, Chen R C
State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.
Shenzhen Institute of Respiratory Diseases, Department of Respiratory and Critical Care Medicine, Shenzhen People's Hospital, First Affiliated Hospital of Southern University of Science and Technology, Second Clinical Medical College of Jinan University, Shenzhen 518020, China.
Zhonghua Jie He He Hu Xi Za Zhi. 2024 Feb 12;47(2):146-151. doi: 10.3760/cma.j.cn112147-20231027-00276.
Non-invasive positive pressure ventilation (NPPV) is a widely used method of providing respiratory support in a variety of clinical settings, including emergency departments, general wards, and intensive care units. The relevant research articles on NPPV published between 1st October 2022 and 30th September 2023 were retrieved from Medline and reviewed. In the management of acute respiratory failure (ARF) associated with COVID-19, studies have highlighted the significant influence of regional economic status on the choice of respiratory support strategies. It has been observed that NPPV is more suitable for patients with mild to moderate acute respiratory distress syndrome (ARDS) than for those with severe ARDS, as the latter group has an increased risk of delayed intubation. In addition, patients with severe dyspnea tended to benefit more from NPPV compared with high flow nasal cannula (HFNC) and conventional oxygen therapy, with a reduced risk of self-induced lung injury. For non-COVID-19-related ARF, research shows no significant differences in mortality and intubation rates between HFNC and NPPV in patients with hypercapnic ARF. The updated HACOR score and ROX score have been validated to have a high predictive value for clinical outcomes in patients receiving NPPV for hypoxemic ARF. With regard to weaning from invasive mechanical ventilation, immediate application of NPPV after extubation showed a lower mortality rate compared to continued invasive weaning. Moreover, NPPV with active humidification significantly decreased the reintubation rate within 7 days after extubation compared with HFNC. The choice between using NPPV and HFNC should be based on the specific etiology of the patient's condition. The potential effect of noninvasive high-frequency oscillatory ventilation on CO clearance was also investigated.
无创正压通气（NPPV）是一种在多种临床环境中广泛使用的提供呼吸支持的方法，包括急诊科、普通病房和重症监护病房。检索了2022年10月1日至2023年9月30日期间发表的关于NPPV的相关研究文章并进行了综述。在与新型冠状病毒肺炎（COVID-19）相关的急性呼吸衰竭（ARF）管理中，研究强调了地区经济状况对呼吸支持策略选择的重大影响。据观察，NPPV更适合轻度至中度急性呼吸窘迫综合征（ARDS）患者，而不是重度ARDS患者，因为后者延迟插管的风险增加。此外，与高流量鼻导管（HFNC）和传统氧疗相比，重度呼吸困难患者从NPPV中获益更多，且自我诱导肺损伤的风险降低。对于非COVID-19相关的ARF，研究表明，在高碳酸血症性ARF患者中，HFNC和NPPV在死亡率和插管率方面无显著差异。更新后的HACOR评分和ROX评分已被验证对接受NPPV治疗低氧血症性ARF患者的临床结局具有较高的预测价值。关于有创机械通气的撤机，拔管后立即应用NPPV与继续有创撤机相比，死亡率较低。此外，与HFNC相比，主动湿化的NPPV显著降低了拔管后7天内的再插管率。使用NPPV和HFNC之间的选择应基于患者病情的具体病因。还研究了无创高频振荡通气对二氧化碳清除的潜在作用。
