Meecham Jones D J, Wedzicha J A
Royal Brompton Hospital (Victoria Park), London, UK.
Eur Respir J. 1993 Jul;6(7):1060-4.
Nasal intermittent positive pressure ventilation (NIPPV) has been widely used in the treatment of chronic respiratory disease. Ventilators may be volume or pressure preset; each type has theoretical advantages, but to date there has been no formal comparison. We wanted to assess the efficacy on blood gas changes that may be achieved and overall acceptability of four nasal ventilators (two pressure preset: Respironics bilevel positive airway pressure (BiPAP) and the Thomas NIPPY; and two volume preset: BromptonPac and Monnal-D) in patients with stable chronic respiratory failure. Median age was 59 yrs (range 48-71 yrs), mean (SD) arterial oxygen tension (PaO2) 7.16 (0.21) kPa, arterial carbon dioxide tension (PaCO2) 7.02 (0.35) kPa, forced expiratory volume in one second (FEV1) 0.76 (0.24) l, and forced vital capacity (FVC) 1.58 (0.49) l. All had previously used NIPPV. There were significant changes in blood gases at 2 h with each ventilator: mean change (95% confidence interval); BiPAP PaO2 +1.52 (0.95-2.09) kPa, PaCO2-1.04 (1.55-0.54) kPa; NIPPY PaO2 +1.63 (0.85-2.41) kPa, PaCO2, -1.1 (1.86-0.34) kPa; BromptonPac PaO2 +1.22 (0.75-1.67) kPa, PaCO2 -1.14 (1.52-0.76) kPa; Monnal-D PaO2 +1.14 (0.42-1.84) kPa, PaCO2 -1.19 (2.14-0.23) kPa. Analysis of variance showed no significant differences in the efficacy of volume or pressure preset equipment, and all ventilators proved equally acceptable to the patients studied. We conclude that all four of the volume or pressure preset ventilators examined are suitable for the delivery of nasal intermittent positive pressure ventilation in patients with stable chronic respiratory failure.
鼻间歇正压通气（NIPPV）已广泛应用于慢性呼吸系统疾病的治疗。呼吸机可预设为容量控制或压力控制模式；每种模式都有理论上的优势，但迄今为止尚未进行过正式比较。我们旨在评估四种鼻用呼吸机（两种压力预设型：瑞思迈双水平气道正压通气（BiPAP）和托马斯NIPPY；两种容量预设型：布朗普顿Pac和莫纳尔-D）对稳定期慢性呼吸衰竭患者血气变化的疗效及总体可接受性。患者中位年龄为59岁（范围48 - 71岁），平均（标准差）动脉血氧分压（PaO2）为7.16（0.21）kPa，动脉血二氧化碳分压（PaCO2）为7.02（0.35）kPa，一秒用力呼气容积（FEV1）为0.76（0.24）L，用力肺活量（FVC）为1.58（0.49）L。所有患者此前均已使用过NIPPV。使用每种呼吸机2小时后血气均有显著变化：平均变化（95%置信区间）；BiPAP：PaO2升高1.52（0.95 - 2.09）kPa，PaCO2降低1.04（1.55 - 0.54）kPa；NIPPY：PaO2升高1.63（0.85 - 2.41）kPa，PaCO2降低1.1（1.86 - 0.34）kPa；布朗普顿Pac：PaO2升高1.22（0.75 - 1.67）kPa，PaCO2降低1.14（1.52 - 0.76）kPa；莫纳尔-D：PaO2升高1.14（0.42 - 1.84）kPa，PaCO2降低1.19（2.14 - 0.23）kPa。方差分析显示容量预设型和压力预设型设备在疗效上无显著差异，并且所有呼吸机对所研究的患者而言均可接受程度相同。我们得出结论，所检查的四种容量或压力预设型呼吸机均适用于为稳定期慢性呼吸衰竭患者提供鼻间歇正压通气。
