Kung Stacey, Semprini Alex C, Kirton Louis W, Fogarin Jess R, Zoellner Sascha K, Beasley Richard, Eathorne Allie, Semprini Ruth A C
Ms. Kung, Dr. Ruth Semprini, and Ms Eathorne are affiliated with Medical Research Institute of New Zealand, Wellington, New Zealand.
Drs. Alex Semprini, Kirton, and Beasley are affiliated with Medical Research Institute of New Zealand, Wellington, New Zealand; and Victoria University Wellington, Wellington, New Zealand.
Respir Care. 2025 Jan;70(1):29-37. doi: 10.1089/respcare.11876.
A noninvasive ventilation (NIV) mask has been designed to deliver NIV with expiratory washout to improve efficacy of ventilation by optimizing clearance of expired gases from the anatomic dead space. This study compared the performance and comfort of a novel investigational mask with expiratory washout with a conventional mask during NIV therapy. In this pilot crossover study, participants with severe stable COPD attended a single visit to receive bi-level NIV through 2 masks; the investigational mask with expiratory washout and a conventional mask. The order of mask use was randomly allocated, and each mask was used for 60 min with a 30-60-min washout in between. The primary outcome was transcutaneous carbon dioxide at 60 min. Other physiologic and NIV device variables were also assessed. The mean difference (95% CI) in the transcutaneous carbon dioxide between the investigational and conventional masks at 60 min, adjusted for baseline, was -0.74 mm Hg, 95% CI -2.81 to 1.33 mm Hg ( = .45). The investigational mask with expiratory washout elicited a lower tidal volume (-128.7 mL, 95% CI -190.0 to -67.3 mL; < .001) and minute ventilation (-2.28 L/min, 95% CI -3.12 to -1.43 L/min; < .001), and a higher leak (7.96 L/min, 95% CI 4.39-11.54 L/min; < .001) than the conventional mask. There were no differences in other physiologic responses or ratings of dyspnea or comfort. NIV therapy delivered by using a novel mask with expiratory washout was similarly effective at reducing transcutaneous carbon dioxide, whereas the delivered tidal volume and minute ventilation were significantly lower when compared with a conventional mask in participants with severe COPD.
一种无创通气（NIV）面罩被设计用于通过优化解剖死腔内呼出气体的清除来进行带有呼气冲洗的无创通气，以提高通气效果。本研究比较了一种新型带有呼气冲洗功能的试验性面罩与传统面罩在无创通气治疗期间的性能和舒适度。在这项前瞻性交叉研究中，患有严重稳定型慢性阻塞性肺疾病（COPD）的参与者接受单次就诊，通过两种面罩接受双水平无创通气；即带有呼气冲洗功能的试验性面罩和传统面罩。面罩使用顺序随机分配，每个面罩使用60分钟，中间有30 - 60分钟的洗脱期。主要结局是60分钟时的经皮二氧化碳分压。还评估了其他生理和无创通气设备变量。在根据基线进行调整后，试验性面罩与传统面罩在60分钟时经皮二氧化碳分压的平均差值（95%置信区间）为-0.74 mmHg，95%置信区间为-2.81至1.33 mmHg（P = 0.45）。与传统面罩相比，带有呼气冲洗功能的试验性面罩引发的潮气量更低（-128.7 mL，95%置信区间为-190.0至-67.3 mL；P < 0.001）、分钟通气量更低（-2.28 L/min，95%置信区间为-3.12至-1.43 L/min；P < 0.001），且漏气量更高（7.96 L/min，95%置信区间为4.39 - 11.54 L/min；P < 0.001）。在其他生理反应、呼吸困难评分或舒适度方面没有差异。使用带有呼气冲洗功能的新型面罩进行无创通气治疗在降低经皮二氧化碳分压方面同样有效，而在患有严重慢性阻塞性肺疾病的参与者中，与传统面罩相比，输送的潮气量和分钟通气量显著更低。
