Restrick L J, Fox N C, Braid G, Ward E M, Paul E A, Wedzicha J A
Department of Thoracic Medicine, London Chest Hospital, UK.
Eur Respir J. 1993 Mar;6(3):364-70.
Nasal intermittent positive pressure ventilation (NIPPV) provides effective ventilatory support in patients with nocturnal hypoventilation. Nasal pressure support ventilation (NPSV), which only provides ventilation in response to patient triggering, may also be effective, simpler, and cheaper, but has not been evaluated. NIPPV and NPSV were compared in 12 patients with nocturnal hypoventilation, requiring domiciliary ventilatory support. The patients were studied on three consecutive nights, in random order: a control night without ventilation and a night on each mode of ventilatory support using the bilevel positive airway pressure (BiPAP) ventilator. Both NIPPV and NPSV significantly increased mean arterial oxygen saturation (SaO2) compared to the control night (NIPPV mean increase 4.1%; 95% confidence interval (CI) 2.2 to 6.1, NPSV 4.4%; CI 2.1 to 6.6) with no significant difference between the two modes. The percentage of the study night spent below 90% SaO2 was significantly reduced by both ventilator modes compared to the control night (median reduction on NIPPV 37%; CI -54 to -10, reduction on NPSV 31%; CI -53 to -9, with no significant difference between NPSV and NIPPV. NPSV was as effective as NIPPV in patients with nocturnal hypoventilation, which suggests that these patients are able to trigger the ventilator adequately. The lower cost of NPSV will make it accessible to more patients with chronic lung disease.
鼻间歇正压通气(NIPPV)可为夜间通气不足的患者提供有效的通气支持。鼻压力支持通气(NPSV)仅在患者触发时提供通气,可能也有效、更简单且更便宜,但尚未得到评估。对12例需要家庭通气支持的夜间通气不足患者进行了NIPPV和NPSV的比较。患者连续三个晚上按随机顺序进行研究:一个无通气的对照夜以及使用双水平气道正压(BiPAP)呼吸机进行每种通气支持模式的一个晚上。与对照夜相比,NIPPV和NPSV均显著提高了平均动脉血氧饱和度(SaO2)(NIPPV平均提高4.1%;95%置信区间(CI)2.2至6.1,NPSV为4.4%;CI 2.1至6.6),两种模式之间无显著差异。与对照夜相比,两种通气模式使研究夜期间SaO2低于90%的时间百分比均显著降低(NIPPV的中位数降低37%;CI -54至-10,NPSV降低31%;CI -53至-9,NPSV和NIPPV之间无显著差异)。在夜间通气不足的患者中,NPSV与NIPPV一样有效,这表明这些患者能够充分触发呼吸机。NPSV较低的成本将使更多慢性肺病患者能够使用。