Wysocki M, Tric L, Wolff M A, Millet H, Herman B
Service de Réanimation Polyvalente, Hôpital International, Université de Paris, France.
Chest. 1995 Mar;107(3):761-8. doi: 10.1378/chest.107.3.761.
The benefit of noninvasive pressure support ventilation (NIPSV) in avoiding the need for endotracheal intubation and reducing morbidity and mortality associated with endotracheal intubation was evaluated in 41 patients who presented with acute respiratory failure not related to chronic obstructive pulmonary disease (COPD). Patients were randomly assigned to receive conventional therapy (n = 20) or conventional therapy plus NIPSV (n = 21). NIPSV was delivered to the patient by a face mask connected to a ventilator (Puritan-Bennett 7200a) set in inspiratory pressure support (IPS) mode. The mean levels of IPS, positive end-expiratory pressure (PEEP), and fraction of inspired oxygen (FIO2) were respectively 15 +/- 3 cm H2O, 4 +/- 2 cm H2O, and 57 +/- 22%. The rate of endotracheal intubation (62 vs 70%, p = 0.88), the length of ICU stay (17 +/- 19 days vs 25 +/- 23 days, p = 0.16), and the mortality rate (33 vs 50%, p = 0.46) were not different between patients treated with NIPSV and those treated conventionally. Post hoc analysis suggested that in patients with PaCO2 > 45 mm Hg (n = 17), NIPSV was associated with a reduction in the rate of endotracheal intubation (36 vs 100%, p = 0.02), in the length of ICU stay (13 +/- 15 days vs 32 +/- 30 days, p = 0.04), and in the mortality rate (9 vs 66%, p = 0.06). We conclude that NIPSV is of no benefit when used systematically in all forms of acute respiratory failure not related to COPD. A subgroup of patients, characterized by acute ventilatory failure and hypercapnia, may potentially benefit from this therapy and further studies are needed to focus on this aspect.
在41例非慢性阻塞性肺疾病（COPD）所致急性呼吸衰竭患者中，评估了无创压力支持通气（NIPSV）在避免气管插管需求以及降低与气管插管相关的发病率和死亡率方面的益处。患者被随机分配接受传统治疗（n = 20）或传统治疗加NIPSV（n = 21）。通过连接到设置为吸气压力支持（IPS）模式的呼吸机（Puritan-Bennett 7200a）的面罩对患者进行NIPSV。IPS、呼气末正压（PEEP）和吸入氧分数（FIO2）的平均水平分别为15±3 cm H2O、4±2 cm H2O和57±22%。接受NIPSV治疗的患者与接受传统治疗的患者相比，气管插管率（62%对70%，p = 0.88）、ICU住院时间（17±19天对25±23天，p = 0.16）和死亡率（33%对50%，p = 0.46）并无差异。事后分析表明，在动脉血二氧化碳分压（PaCO2）> 45 mmHg的患者（n = 17）中，NIPSV与气管插管率降低（36%对100%，p = 0.02）、ICU住院时间缩短（13±15天对32±30天，p = 0.04）以及死亡率降低（9%对66%，p = 0.06）相关。我们得出结论，在所有非COPD所致急性呼吸衰竭中系统性使用NIPSV并无益处。以急性通气衰竭和高碳酸血症为特征的亚组患者可能会从该治疗中获益，需要进一步研究关注这一方面。
