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COVID-19 相关急性呼吸衰竭的无创机械通气。

NONINVASIVE MECHANICAL VENTILATION IN COVID-19 RELATED ACUTE RESPIRATORY FAILURE.

机构信息

Jordanovac Department of Respiratory Diseases, Zagreb University Hospital Center, Zagreb, Croatia.

School of Medicine, University of Zagreb, Zagreb, Croatia.

出版信息

Acta Clin Croat. 2023 Apr;62(Suppl1):125-131. doi: 10.20471/acc.2023.62.s1.16.

Abstract

Coronavirus disease 2019 (COVID-19) is presented with a wide range of symptoms, from asymptomatic disease to severe and progressive interstitial pneumonia. As part of interstitial pneumonia, respiratory failure is typically presented as hypoxia and is the most common cause of hospitalization. When oxygen therapy fails, continuous positive airway pressure (CPAP) or noninvasive mechanical ventilation (NIV) are used as respiratory support measures of first choice. Noninvasive respiratory support (NIRS) is applied in order to save intensive care unit resources and to avoid complications related to invasive mechanical ventilation. Emerging evidence has shown that the use of CPAP or NIV in the management of acute hypoxemic respiratory failure in COVID-19 reduces the need for intubation and mortality. The advantage of NIRS is the feasibility of its application on wards. NIV could be administered a face mask or helmet interface. Helmet adheres better than mask and therefore leakage is reduced, a delivery of positive end-expiratory pressure is more accurate, and the risk of nosocomial transmission of infections is lowered. Patients on NIRS must be carefully monitored so that further respiratory deterioration is not overlooked and additional measures of care including timely intubation and invasive mechanical ventilation could be performed if needed.

摘要

新型冠状病毒病(COVID-19)的症状范围广泛,从无症状疾病到严重和进行性间质性肺炎。作为间质性肺炎的一部分,呼吸衰竭通常表现为缺氧,是住院的最常见原因。当氧疗失败时,持续气道正压通气(CPAP)或无创机械通气(NIV)作为首选的呼吸支持措施。应用无创呼吸支持(NIRS)是为了节省重症监护病房的资源,并避免与有创机械通气相关的并发症。新出现的证据表明,在 COVID-19 急性低氧性呼吸衰竭的管理中使用 CPAP 或 NIV 可降低插管和死亡率的需求。NIRS 的优点在于其在病房中的可行性。NIV 可以通过面罩或头盔接口进行。头盔比面罩更贴合,因此泄漏减少,呼气末正压的输送更准确,医院感染的传播风险降低。接受 NIRS 的患者必须密切监测,以免忽视进一步的呼吸恶化,并在需要时采取包括及时插管和有创机械通气在内的其他护理措施。

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