Wysocki M, Tric L, Wolff M A, Gertner J, Millet H, Herman B
Service de réanimation polyvalente, Hôpital International Université de Paris, France.
Chest. 1993 Mar;103(3):907-13. doi: 10.1378/chest.103.3.907.
To further delineate indications for noninvasive pressure support ventilation (NIPSV), we proposed this noninvasive technique as an alternative to endotracheal intubation in 17 consecutive patients with acute respiratory failure from various causes. Eight patients (47 percent) were successfully ventilated with NIPSV, while in 9 (53 percent), NIPSV failed. Gas exchange values before initiating NIPSV were different between the 2 groups: patients successfully ventilated with NIPSV had a higher PaCO2 (57 +/- 15 mm Hg vs 37 +/- 17 mm Hg; p = 0.01), a lower pH (7.33 +/- 0.03 vs 7.45 +/- 0.08; p = 0.02), and a lower alveolo-arterial oxygen pressure difference (P[A-a]O2) (144 +/- 46 mm Hg vs 265 +/- 18 mm Hg; p = 0.01), suggesting that CO2 retention without major hypoxemia is a better indication for NIPSV than severe hypoxemia alone. Acute respiratory failure occurring after extubation seemed to be a good indication for NIPSV, with an 83 percent rate of success. In both groups of patients, gas exchange improved after 1 h on NIPSV, but such values were not improved on the first day in patients who failed with NIPSV.
为了进一步明确无创压力支持通气（NIPSV）的适应证，我们对17例因各种原因导致急性呼吸衰竭的连续患者采用了这种无创技术作为气管插管的替代方法。8例患者（47%）通过NIPSV成功通气，而9例（53%）患者NIPSV失败。启动NIPSV前两组的气体交换值不同：通过NIPSV成功通气的患者PaCO2较高（57±15 mmHg对37±17 mmHg；p = 0.01），pH较低（7.33±0.03对7.45±0.08；p = 0.02），肺泡-动脉氧分压差（P[A-a]O2）较低（144±46 mmHg对265±18 mmHg；p = 0.01），这表明无严重低氧血症的二氧化碳潴留比单纯严重低氧血症更适合NIPSV。拔管后发生的急性呼吸衰竭似乎是NIPSV的良好适应证，成功率为83%。两组患者在NIPSV治疗1小时后气体交换均有改善，但NIPSV失败的患者在第一天气体交换值未改善。
