Barbé F, Togores B, Rubí M, Pons S, Maimó A, Agustí A G
Servei Pneumología, Hospital Univ. Son Dureta, Palma de Mallorca, Spain.
Eur Respir J. 1996 Jun;9(6):1240-5. doi: 10.1183/09031936.96.09061240.
This investigation evaluates, in a prospective, randomized and controlled manner, whether noninvasive ventilatory support (NIVS) with bilevel positive airway pressure (BiPAP) facilitates recovery from acute respiratory failure (ARF) in patients with chronic obstructive pulmonary disease (COPD). Twenty four patients (mean age (+/-SEM) 68 +/- 2 yrs) with COPD (forced expiratory volume in one second (FEV1) at discharge 33 +/- 2% predicted), who attended the emergency room because of ARF (pH 7.33 +/- 0.01; arterial oxygen tension (Pa,O2) 6.0 +/- 0.2 kPa; arterial carbon dioxide tension (Pa,CO2) 7.9 +/- 0.3 kPa), were initially randomized. Four out of the 14 patients (29%) allocated to received NIVS did not tolerate it. Of the remaining 20 patients, 10 received NIVS with BiPAP in a conventional hospital ward during the first 3 days of hospitalization (two daytime sessions of 3 h duration each). All 20 subjects were treated with oxygen, bronchodilators and steroids. On the first and third hospitalization days, before and 30 min after withdrawing oxygen therapy and/or BiPAP ventilatory support, we measured peak expiratory flow, arterial blood gas values, ventilatory pattern, occlusion pressure (P0.1), and maximal inspiratory (MIP) and maximal expiratory (MEP) pressures. All patients were discharged without requiring tracheal intubation and mechanical ventilation. Hospitalization time was similar in both groups (11.3 +/- 1.3 vs 10.6 +/- 0.9 days, control vs BiPAP, respectively). Arterial oxygenation, respiratory acidosis and airflow obstruction improved significantly throughout hospitalization in both groups. By contrast, the ventilatory pattern, P0.1, MIP and MEP did not change. NIVS with BiPAP did not cause any significant difference between groups. We conclude that noninvasive ventilatory support with bilevel positive airway pressure does not facilitate recovery from acute respiratory failure in patients with chronic obstructive pulmonary disease. Furthermore, a substantial proportion of patients (29%) do not tolerate noninvasive ventilatory support under these circumstances. From these results, we cannot recommend the use of noninvasive ventilatory support with bilevel positive airway pressure in the routine management of chronic obstructive pulmonary disease patients recovering from acute respiratory failure.
本研究以前瞻性、随机对照的方式，评估采用双水平气道正压通气（BiPAP）的无创通气支持（NIVS）是否有助于慢性阻塞性肺疾病（COPD）患者从急性呼吸衰竭（ARF）中恢复。24例因ARF（pH 7.33±0.01；动脉血氧分压（Pa,O2）6.0±0.2 kPa；动脉血二氧化碳分压（Pa,CO2）7.9±0.3 kPa）就诊于急诊室的COPD患者（平均年龄（±标准误）68±2岁，出院时第一秒用力呼气容积（FEV1）为预计值的33±2%）最初被随机分组。分配接受NIVS的14例患者中有4例（29%）不耐受。在其余20例患者中，10例在住院的前3天于常规医院病房接受BiPAP无创通气支持（每天白天各进行2次，每次持续3小时）。所有20例受试者均接受了氧疗、支气管扩张剂和类固醇治疗。在住院第1天和第3天，撤掉氧疗和/或BiPAP通气支持前及撤掉后30分钟，我们测量了呼气峰值流速、动脉血气值、通气模式、阻断压（P0.1）以及最大吸气（MIP）和最大呼气（MEP）压力。所有患者均未行气管插管和机械通气而出院。两组患者的住院时间相似（对照组与BiPAP组分别为11.3±1.3天和10.6±0.9天）。两组患者在整个住院期间动脉氧合、呼吸性酸中毒和气流阻塞均有显著改善。相比之下，通气模式、P0.1、MIP和MEP未发生变化。BiPAP无创通气支持在两组之间未造成任何显著差异。我们得出结论，双水平气道正压无创通气支持并不能促进慢性阻塞性肺疾病患者从急性呼吸衰竭中恢复。此外，在这些情况下，相当一部分患者（29%）不耐受无创通气支持。基于这些结果，我们不建议在常规管理从急性呼吸衰竭中恢复的慢性阻塞性肺疾病患者时使用双水平气道正压无创通气支持。
