Miro A M, Shivaram U, Hertig I
Department of Anesthesiology and Critical Care Medicine, University of Pittsburgh School of Medicine.
Chest. 1993 Jan;103(1):266-8. doi: 10.1378/chest.103.1.266.
We used mask continuous positive airway pressure (CPAP) in seven patients with acute hypercapnic respiratory failure in an attempt to avoid endotracheal intubation and mechanical ventilation. Mask CPAP was started at 5 cm H2O and then increased to a maximum of 10 cm H2O depending on the clinical response. In five patients, CPAP significantly improved gas exchange; four of these patients were weaned to oxygen by face mask without needing intubation. In two patients, gas exchange deteriorated even with CPAP of 10 cm H2O. No barotrauma or adverse hemodynamic effects were associated with CPAP. We conclude that a trial of mask CPAP may be warranted before intubation of an alert, acutely hypercapnic patient with COPD.
我们对7例急性高碳酸血症呼吸衰竭患者使用面罩持续气道正压通气（CPAP），试图避免气管插管和机械通气。面罩CPAP起始压力为5 cm H₂O，然后根据临床反应最高增加至10 cm H₂O。5例患者的气体交换得到显著改善；其中4例患者通过面罩吸氧撤机，无需插管。2例患者即使使用10 cm H₂O的CPAP，气体交换仍恶化。未发现CPAP相关的气压伤或不良血流动力学效应。我们得出结论，对于清醒的、患有慢性阻塞性肺疾病（COPD）且急性高碳酸血症的患者，在插管前进行面罩CPAP试验可能是必要的。
