Department of Medicine, Pulmonary & Critical Care Division, UMASS Chan Medical School-Baystate, Springfield, MA.
Heart and Vascular Research, Baystate Medical Center, Springfield, MA.
Chest. 2024 Jun;165(6):1469-1480. doi: 10.1016/j.chest.2024.02.040. Epub 2024 Feb 28.
When administered as first-line intervention to patients admitted with acute hypercapnic respiratory failure secondary to COPD exacerbation in conjunction with guideline-recommended therapies, noninvasive ventilation (NIV) has been shown to reduce mortality and endotracheal intubation. Opportunities to increase uptake of NIV continue to exist despite inclusion of this therapy in clinical guidelines. Identifying patients appropriate for NIV, and subsequently providing close monitoring to determine an improvement in clinical condition involves a team consisting of physician, nurse, and respiratory therapist in institutions that successfully implement NIV. We describe to our knowledge the first known evidence-based algorithm speaking to initiation, titration, monitoring, and weaning of NIV in treatment of acute exacerbation of COPD that incorporates the necessary interprofessional collaboration among physicians, nurses, and respiratory therapists caring for these patients.
当无创通气（NIV）与指南推荐的治疗方法联合用于治疗因 COPD 加重而导致的急性高碳酸血症性呼吸衰竭的住院患者的一线干预时，已证明其可降低死亡率和气管插管率。尽管该疗法已纳入临床指南，但仍有机会增加 NIV 的应用。确定适合 NIV 的患者，随后通过密切监测以确定临床状况的改善，需要由医生、护士和呼吸治疗师组成的团队在成功实施 NIV 的机构中进行。我们认为，我们所描述的是第一个针对 COPD 急性加重治疗中 NIV 的启动、滴定、监测和脱机的循证算法，该算法纳入了照顾这些患者的医生、护士和呼吸治疗师之间的必要的跨专业协作。
