Spessert C K, Weilitz P B, Goodenberger D M
Respiratory and Critical Care Division, Washington University School of Medicine, St. Louis, MO 63110.
Am J Crit Care. 1993 Jan;2(1):54-60.
Respiratory failure related to neuromuscular weakness has commonly been managed with long-term ventilation by tracheostomy. Currently, nasal positive pressure ventilation is being used with success in this patient population. It has been suggested that initiation of nasal positive pressure ventilation is best done in an intensive care setting.
Nine patients were placed on nasal ventilation during a brief admission to a medical floor staffed by nurses trained in respiratory care. This process was facilitated by use of a standardized protocol for nursing staff that identified treatment objectives.
Following the initiation of nasal positive pressure ventilation, this group of patients experienced near normalization of daytime measurements of partial pressure of arterial carbon dioxide, reported increases in daytime energy levels, and relief of nighttime signs and symptoms. These objectives were accomplished with no significant complications. Use of this protocol may also decrease length and cost of hospitalization and improve patient acceptance of noninvasive ventilatory assistance.
与神经肌肉无力相关的呼吸衰竭通常通过气管切开术进行长期通气治疗。目前，鼻正压通气在这类患者中取得了成功应用。有人提出，鼻正压通气最好在重症监护环境中开始使用。
9名患者在短暂入住配备有经过呼吸护理培训的护士的内科病房期间接受鼻通气治疗。通过为护理人员使用确定治疗目标的标准化方案，促进了这一过程。
在开始鼻正压通气后，这组患者白天动脉血二氧化碳分压测量值接近正常，报告白天能量水平增加，夜间体征和症状缓解。这些目标在没有重大并发症的情况下得以实现。使用该方案还可能缩短住院时间和降低住院费用，并提高患者对无创通气辅助的接受度。
