Abou-Shala N, Meduri U
Section of Critical Care Medicine, King Faisal Hospital and Research Center, Riyadh, Saudi Arabia.
Crit Care Med. 1996 Apr;24(4):705-15. doi: 10.1097/00003246-199604000-00025.
a) To describe the introduction of noninvasive means to provide positive-pressure ventilation in acute respiratory failure; b) to describe the physiologic response to noninvasive ventilation; c) to review the current published literature on using noninvasive ventilation in patients with acute hypercapnic and/or hypoxemic respiratory failure; d) to describe the technique of applying mask ventilation and current recommendations for using noninvasive ventilation and current recommendations for using noninvasive ventilation in patients with acute respiratory failure; and e) to discuss the advantages and disadvantages of noninvasive ventilation.
All relevant articles published in the English medical literature from 1988 through August 1994 were retrieved through a MEDLINE search, as well as from the author's experience.
Studies were selected based on the use of positive-pressure mechanical ventilation delivered, using facial or nasal masks in various acute settings of respiratory failure.
The authors extracted all applicable data.
Studies were analyzed according to the type of respiratory failure (hypercapnic vs. hypoxemic) and underlying conditions where noninvasive ventilation seemed to be a better alternative. The results were evaluated based on types of masks used and modes of ventilation. Outcome measures were compared based on studies that randomized patients with acute respiratory failure to receive noninvasive vs. conventional therapy. Complications of noninvasive ventilation, mainly local, were compared with those complications seen endotracheal intubation in acute respiratory failure patients.
Noninvasive ventilation is a safe and effective means of ventilatory support for many patients with acute respiratory failure. Noninvasive ventilation is well tolerated, principally because it allows the patient to be in control and to continue verbal communication, and should be strongly considered in managing terminally ill patients with potentially reversible causes of respiratory failure. The duration of mechanical ventilation and its associated complications are significantly decreased in hypercapnic respiratory failure with noninvasive ventilation.
a）描述在急性呼吸衰竭中引入无创方式提供正压通气；b）描述对无创通气的生理反应；c）回顾当前已发表的关于在急性高碳酸血症和/或低氧血症呼吸衰竭患者中使用无创通气的文献；d）描述应用面罩通气的技术以及当前对急性呼吸衰竭患者使用无创通气的建议；e）讨论无创通气的优缺点。
通过医学文献数据库检索1988年至1994年8月期间发表在英文医学文献中的所有相关文章，以及作者的经验。
根据在各种急性呼吸衰竭情况下使用面部或鼻罩进行正压机械通气来选择研究。
作者提取了所有适用数据。
根据呼吸衰竭的类型（高碳酸血症型与低氧血症型）以及无创通气似乎是更好选择的基础疾病对研究进行分析。根据所使用的面罩类型和通气模式评估结果。基于将急性呼吸衰竭患者随机分为接受无创治疗与传统治疗的研究比较结局指标。将无创通气的并发症（主要是局部并发症）与急性呼吸衰竭患者气管插管所见的并发症进行比较。
无创通气是许多急性呼吸衰竭患者通气支持的一种安全有效的手段。无创通气耐受性良好，主要是因为它允许患者自主控制并继续言语交流，对于患有潜在可逆性呼吸衰竭病因的晚期患者的管理应强烈考虑使用。在高碳酸血症性呼吸衰竭中，无创通气可显著缩短机械通气时间及其相关并发症。
