Meyer T J, Hill N S
Brown University School of Medicine, Providence, Rhode Island.
Ann Intern Med. 1994 May 1;120(9):760-70. doi: 10.7326/0003-4819-120-9-199405010-00008.
To review the clinical use of noninvasive positive pressure ventilation, including its efficacy with acute and chronic forms of respiratory failure, its mechanism of action, and its implementation.
Studies were identified through a MEDLINE search using the key words respiratory failure and mechanical ventilation and through a manual review of reference lists of published articles.
All original studies relating to the use of noninvasive positive pressure ventilation in respiratory failure were included. Because of the paucity of controlled trials, cohort studies were not excluded.
Study design, numbers and diagnoses of patients, ventilator modes, and success and complication rates were extracted and compiled.
For acute respiratory failure, studies report improved gas exchange and avoidance of intubation in 60% to 80% of patients with chronic obstructive pulmonary disease, restrictive thoracic disease, congestive heart failure, pneumonia, or postoperative extubation failure. However, the patients were highly selected, and relatively few studies have been published, only one of which was a randomized controlled trial. For chronic respiratory failure due to restrictive thoracic disease, all studies report improved gas exchange and symptoms of hypoventilation after prolonged nocturnal use, although no study was controlled. Some cohort studies of patients with severe chronic obstructive pulmonary disease yielded favorable results, but longer-term, randomized, controlled studies showed minimal, if any, benefit.
Noninvasive positive pressure ventilation is effective in the treatment of chronic respiratory failure due to restrictive thoracic diseases. The routine use of such treatment for chronic respiratory failure due to chronic obstructive pulmonary disease and for acute respiratory failure needs to be studied in randomized controlled trials in better-defined patient subsets.
回顾无创正压通气的临床应用，包括其对急慢性呼吸衰竭的疗效、作用机制及实施方法。
通过使用关键词“呼吸衰竭”和“机械通气”在MEDLINE数据库进行检索，并人工查阅已发表文章的参考文献列表来确定研究。
纳入所有与无创正压通气在呼吸衰竭中的应用相关的原始研究。由于对照试验较少，队列研究未被排除。
提取并汇总研究设计、患者数量和诊断、通气模式以及成功率和并发症发生率。
对于急性呼吸衰竭，研究报告显示，慢性阻塞性肺疾病、限制性胸壁疾病、充血性心力衰竭、肺炎或术后拔管失败的患者中，60%至80%的患者气体交换得到改善且避免了插管。然而，这些患者是经过高度选择的，且发表的研究相对较少，其中只有一项是随机对照试验。对于由限制性胸壁疾病导致的慢性呼吸衰竭，所有研究均报告长期夜间使用后气体交换改善且通气不足症状减轻，尽管没有研究设立对照。一些对重度慢性阻塞性肺疾病患者的队列研究取得了良好结果，但长期的随机对照研究显示益处甚微（如果有的话）。
无创正压通气对治疗限制性胸壁疾病所致慢性呼吸衰竭有效。对于慢性阻塞性肺疾病所致慢性呼吸衰竭及急性呼吸衰竭，这种治疗方法的常规应用需要在定义更明确的患者亚组中进行随机对照试验研究。
