Carteaux Guillaume, Haudebourg Anne-Fleur
AP-HP, Hôpitaux Universitaires Henri-Mondor, Service de Médecine Intensive Réanimation, 94010, Créteil, France.
Faculté de Santé, Groupe de Recherche Clinique CARMAS, Université Paris Est-Créteil, Créteil 94010, France.
J Intensive Med. 2025 Mar 4;5(3):237-245. doi: 10.1016/j.jointm.2025.01.001. eCollection 2025 Jul.
acute hypoxemic respiratory failure (AHRF) remains one of the leading causes of intensive care unit (ICU) admission and is still associated with high rates of intubation and mortality. Developing effective strategies to prevent intubation and its associated complications remains a critical objective in this population. Noninvasive ventilation (NIV) has been proposed as a potential alternative to invasive ventilation in AHRF. However, no clear clinical benefit has been consistently demonstrated to date. The lack of definitive evidence has left experts unable to provide recommendations for the use of NIV in AHRF. Several factors may account for the inconsistencies in the literature and merit further investigation. Identifying early predictive criteria for NIV failure could be essential in determining which patients are most likely to benefit from this intervention. In addition, the approach to NIV settings may require reconsideration, particularly regarding the level of assistance. Efforts to reduce tidal volume, while aiming to minimize ventilator-induced lung injury, may have inadvertently resulted in insufficient support, amplifying the harmful effects of excessive inspiratory effort. The choice of interface may also significantly influence the physiological effects and outcomes and warrants further exploration. Finally, the frugal nature of noninvasive techniques makes them well-suited for the universal management of AHRF, regardless of constraints. This highlights the need for future developments aimed at optimizing oxygen and energy efficiency, enhancing the ease of use and robustness of NIV devices, and evaluating the effectiveness of NIV under high-constraint conditions, such as in low- and middle-income countries. This review addresses these critical questions.
急性低氧性呼吸衰竭（AHRF）仍然是重症监护病房（ICU）收治的主要原因之一，并且仍然与高插管率和死亡率相关。制定有效的策略来预防插管及其相关并发症仍然是这一人群的关键目标。无创通气（NIV）已被提议作为AHRF中有创通气的一种潜在替代方法。然而，迄今为止，尚未始终如一地证明其具有明确的临床益处。缺乏确凿的证据使得专家无法就AHRF中使用NIV提供建议。几个因素可能解释了文献中的不一致之处，值得进一步研究。确定NIV失败的早期预测标准对于确定哪些患者最有可能从这种干预中获益可能至关重要。此外，NIV设置的方法可能需要重新考虑，特别是关于辅助水平。在旨在尽量减少呼吸机诱发的肺损伤的同时努力降低潮气量，可能无意中导致支持不足，放大了过度吸气努力的有害影响。接口的选择也可能显著影响生理效应和结果，值得进一步探索。最后，无创技术的节俭性质使其非常适合AHRF的普遍管理，无论有无限制。这突出了未来发展的必要性，旨在优化氧气和能量效率，提高NIV设备的易用性和耐用性，并评估NIV在高限制条件下（如在低收入和中等收入国家）的有效性。本综述探讨了这些关键问题。
