Smith I E, Shneerson J M
Respiratory Support and Sleep Centre, Papworth Hospital, Cambridge, UK.
Thorax. 1997 Jan;52(1):89-91. doi: 10.1136/thx.52.1.89.
Some patients started on nasal intermittent positive pressure ventilation (NIPPV) with the Monnal D ventilator deteriorate after a period. The effects of changing them to the Nippy ventilator were investigated.
The records of such patients were examined retrospectively. Comparisons were made between blood gas tensions and overnight oximetry records before NIPPV, 12 weeks after the initiation of NIPPV with the Monnal D, at the time of deterioration, and 12 weeks after initiation of treatment with the Nippy ventilator.
Ten patients (seven women) were identified. Prior to starting NIPPV their mean (SD) age was 59.6 (8.39) years and their mean arterial oxygen and carbon dioxide tensions (PaO2 and PaCO2) while breathing air were 6.1 (1.79) and 9.6 (3.28) kPa, respectively. All were started on NIPPV with the Monnal D with improvements in symptoms, PaO2, PaCO2, and overnight oximetry after 12 weeks of treatment. After a mean interval of 118 (69.0) weeks all measures of ventilation had deteriorated and the patients were converted to the Nippy ventilator. Twelve weeks after initiation of treatment with the Nippy ventilator symptoms and overnight oximetry were improved again and the mean PaO2 and PaCO2 were 8.9 (1.27) and 6.9 (0.45) kPa, respectively. After a total mean period of 59 (26.9) weeks on the Nippy all but one of the patients have maintained this improvement.
Support with NIPPV using the Monnal D ventilator may fail after an interval and changing to the Nippy ventilator can reverse this deterioration, probably because of its superior responsiveness to leaks and patient effort. The regular follow up of patients on long term NIPPV is necessary if secondary treatment failure is to be identified and effectively treated.
一些开始使用莫纳尔D型呼吸机进行鼻间歇正压通气（NIPPV）的患者在一段时间后病情恶化。研究了将他们更换为尼皮呼吸机的效果。
回顾性检查这些患者的记录。比较了NIPPV治疗前、使用莫纳尔D型呼吸机进行NIPPV治疗12周后、病情恶化时以及使用尼皮呼吸机治疗12周后的血气张力和夜间血氧饱和度记录。
共确定了10例患者（7名女性）。开始NIPPV治疗前，他们的平均（标准差）年龄为59.6（8.39）岁，呼吸空气时的平均动脉血氧和二氧化碳张力（PaO2和PaCO2）分别为6.1（1.79）kPa和9.6（3.28）kPa。所有患者均开始使用莫纳尔D型呼吸机进行NIPPV治疗，治疗12周后症状、PaO2、PaCO2和夜间血氧饱和度均有所改善。平均间隔118（69.0）周后，所有通气指标均恶化，患者更换为尼皮呼吸机。使用尼皮呼吸机治疗12周后，症状和夜间血氧饱和度再次改善，平均PaO2和PaCO2分别为8.9（1.27）kPa和6.9（0.45）kPa。在使用尼皮呼吸机平均总时长为59（26.9）周后，除1例患者外，其他患者均维持了这种改善。
使用莫纳尔D型呼吸机进行NIPPV支持可能在一段时间后失效，更换为尼皮呼吸机可逆转这种恶化，可能是因为其对漏气和患者用力的反应性更好。如果要识别并有效治疗继发性治疗失败，对长期接受NIPPV治疗的患者进行定期随访是必要的。
