Criner G J, Travaline J M, Brennan K J, Kreimer D T
Division of Pulmonary and Critical Care Medicine, Temple University School of Medicine, Philadelphia.
Chest. 1994 Oct;106(4):1109-15. doi: 10.1378/chest.106.4.1109.
Previous studies have shown that noninvasive positive pressure ventilation (NPPV) improves gas exchange in acute and chronic respiratory failure. However, some patients are unable to tolerate NPPV due to air leaks around the mask, facial discomfort, and claustrophobia. A new mask that covers the entire face (Total, Respironics, Monroeville, Pa), attempts to overcome these obstacles. We studied the efficacy of NPPV via the Total face mask (TFM) in nine patients with chronic respiratory failure. In three patients, respiratory failure was due to chronic obstructive lung disease, and in six patients, it was secondary to restrictive disorders. None of the patients were previously able to tolerate NPPV via nasal (N) or nasal-oral (NO) masks. At baseline, all patients had impaired gas exchange with low PaO2/FIO2 (241 +/- 14), elevated PaCO2 (79 +/- 5 mm Hg), and poor functional status (1.89 +/- 1.45, on a scale of 1 to 7). After NPPV in the hospital for 7.1 +/- 1.5 h per night for 22 +/- 26 days, the PaCO2 fell to 59 +/- 3 mm Hg, and the PaO2/FIO2 rose to 304 +/- 27. Following nocturnal NPPV via the TFM for 6.7 +/- 1.5 h a night 6 +/- 5 weeks after hospital discharge, sustained improvements in PaCO2 (58 +/- 3 mm Hg, p < 0.05), PaO2/FIO2 (304 +/- 18), and functional status (5.38 +/- 1.06, p < 0.05) were observed. In four patients, measurements of respiratory rate, tidal volume, minute ventilation, dyspnea, discomfort with the face mask, and mask and mouth leaks were made during 30-min sessions of NPPV applied at constant levels via all three masks (N, NO, TFM). Discomfort with the face mask (0.38 +/- 0.18 vs 1.44 +/- 0.34 vs 2.38 +/- 0.32, p < 0.05) and mask leaks (0.44 +/- 0.18 vs 1.89 +/- 0.39 vs 1.89 +/- 0.35, p < 0.05) were least during NPPV via TFM compared with the N or NO masks, respectively. Moreover, expired tidal volume was highest (804 +/- 10 vs 498 +/- 9 vs 537 +/- 13 ml, p < 0.05) and PaCO2 lowest (51 +/- 2 vs 57 +/- 2 vs 58 +/- 3, p < 0.05) during NPPV via the TFM compared with N or NO masks. We conclude that NPPV delivered via a Total mask ensures a comfortable, stable patient-mask interface and improves gas exchange in selected patients intolerant of more conventional N or NO masks.
以往研究表明，无创正压通气（NPPV）可改善急慢性呼吸衰竭患者的气体交换。然而，部分患者因面罩周围漏气、面部不适及幽闭恐惧症而无法耐受NPPV。一种覆盖整个面部的新型面罩（Total，瑞思迈公司，宾夕法尼亚州门罗维尔）试图克服这些障碍。我们研究了通过全脸面罩（TFM）对9例慢性呼吸衰竭患者进行NPPV的疗效。其中3例患者呼吸衰竭由慢性阻塞性肺疾病引起，6例患者继发于限制性疾病。所有患者此前均无法耐受经鼻（N）或口鼻（NO）面罩进行的NPPV。基线时，所有患者气体交换均受损，动脉血氧分压/吸入氧分数（PaO2/FIO2）较低（241±14），动脉血二氧化碳分压（PaCO2）升高（79±5 mmHg），功能状态较差（1.89±1.45，1至7分）。在医院每晚进行7.1±1.5小时的NPPV，持续22±26天后，PaCO2降至59±3 mmHg，PaO2/FIO2升至304±27。出院后6±5周，每晚通过TFM进行6.7±1.5小时的夜间NPPV，观察到PaCO2（58±3 mmHg，p<0.05）、PaO2/FIO2（304±18）和功能状态（5.38±1.06，p<0.05）持续改善。对4例患者在使用三种面罩（N、NO、TFM）以恒定水平进行30分钟NPPV期间测量呼吸频率、潮气量、分钟通气量、呼吸困难、对面罩的不适感以及面罩和口腔漏气情况。与N或NO面罩相比，通过TFM进行NPPV时，对面罩的不适感（0.38±0.18 vs 1.44±0.34 vs 2.38±0.32，p<0.05）和面罩漏气（0.44±0.18 vs 1.89±0.39 vs 1.89±0.35，p<0.05）最少。此外，与N或NO面罩相比，通过TFM进行NPPV时呼出潮气量最高（804±10 vs 498±9 vs 537±13 ml，p<0.05），PaCO2最低（51±2 vs 57±2 vs 58±3，p<0.05）。我们得出结论，通过全脸面罩进行NPPV可确保患者与面罩之间舒适、稳定的界面，并改善部分无法耐受传统N或NO面罩的患者的气体交换。
