Darioli R, Perret C
Am Rev Respir Dis. 1984 Mar;129(3):385-7. doi: 10.1164/arrd.1984.129.3.385.
This study reports the results obtained with mechanical ventilation in severe respiratory failure secondary to status asthmaticus. Of the 159 patients with status asthmaticus admitted to the Intensive Respiratory Unit over a 5-yr period, 26 required mechanical ventilation for a total of 34 episodes of acute respiratory acidosis. At the time of intubation, 10 patients were in coma and 5 were in respiratory arrest. Controlled mechanical ventilation was maintained for a mean of 2.5 days. Complications were few and reversible. All patients survived. These favorable results are attributed to a new strategy: mechanical ventilation is used to obtain a correction of hypoxemia with hyperoxic mixtures without attempting to restore an adequate alveolar ventilation. The respirator is adjusted to avoid high airway pressures, which appear to be more dangerous than persistent hypercapnia itself. Correction of hypercapnia is obtained later when bronchial obstruction relief provides better conditions of ventilation-perfusion distribution. So the risks of barotrauma and cardiocirculatory failure, which are frequently reported as fatal complications, appear to be significantly decreased.
本研究报告了对哮喘持续状态继发的严重呼吸衰竭患者进行机械通气所取得的结果。在5年期间入住强化呼吸病房的159例哮喘持续状态患者中，26例因总共34次急性呼吸性酸中毒发作而需要机械通气。插管时，10例患者处于昏迷状态，5例患者出现呼吸骤停。控制性机械通气平均维持2.5天。并发症较少且可逆转。所有患者均存活。这些良好结果归因于一种新策略：使用机械通气通过高氧混合气纠正低氧血症，而不试图恢复足够的肺泡通气。调整呼吸机以避免出现高气道压力，因为高气道压力似乎比持续性高碳酸血症本身更危险。当支气管阻塞缓解后提供更好的通气-灌注分布条件时，再纠正高碳酸血症。因此，经常被报道为致命并发症的气压伤和心循环衰竭风险似乎显著降低。
