Pope J F, Birnkrant D J, Martin J E, Repucci A H
Department of Pediatrics, MetroHealth Medical Center, Case Western Reserve University, School of Medicine, Cleveland, Ohio 44109-1998, USA.
Pediatr Pulmonol. 1997 Jun;23(6):468-71. doi: 10.1002/(sici)1099-0496(199706)23:6<468::aid-ppul13>3.0.co;2-2.
Noninvasive positive pressure ventilation (NPPV) is used for respiratory support in a number of diseases causing acute or chronic respiratory failure. We describe a novel use of NPPV to provide respiratory support during sedation for percutaneous placement of a gastrostomy tube in a patient with Duchenne muscular dystrophy (DMD). The patient had severe respiratory insufficiency, progressive dysphagia, and undernutrition. In addition to the case in this report, we have used NPPV to provide respiratory support to DMD patients during five other gastrointestinal endoscopies without complication. The technique is highly labor intensive and requires physicians and respiratory therapists familiar with NPPV. The primary risk associated with this technique is lack of definitive airway protection during the procedure, which must be balanced against the risks of intubation in an anesthetized patient with neuromuscular disease. The potential benefit to selected patients is substantial, such as initiation of gastrostomy tube feeding in our patient, with subsequent improvement in his quality of life and nutritional status.
无创正压通气（NPPV）用于多种导致急性或慢性呼吸衰竭疾病的呼吸支持。我们描述了NPPV的一种新用途，即在对一名杜氏肌营养不良症（DMD）患者进行经皮胃造瘘管置入术的镇静过程中提供呼吸支持。该患者有严重的呼吸功能不全、进行性吞咽困难和营养不良。除了本报告中的病例外，我们还在另外五次胃肠内镜检查中使用NPPV为DMD患者提供呼吸支持，均无并发症。该技术劳动强度极大，需要熟悉NPPV的医生和呼吸治疗师。与该技术相关的主要风险是在操作过程中缺乏明确的气道保护，这必须与麻醉状态下患有神经肌肉疾病患者的插管风险相权衡。对选定患者的潜在益处是巨大的，比如我们的患者开始通过胃造瘘管进食，随后其生活质量和营养状况得到改善。
