Schneider H
Zentrum für Innere Medizin, Klinikum der Philipps-Universität Marburg.
Med Klin (Munich). 1997 Apr 28;92 Suppl 1:123-4.
Patients who develop acute exacerbation of a chronic pulmonary disease (COPD), neuromuscular dysfunction and/or disorders of the ventilator control often require assistance of ventilation. transtracheal intubation presents risks of nosocomial pneumonia and injuries. There is general agreement that in patients with chronic alveolar hypoventilation noninvasive positive pressure ventilatory assistance improves ventilation, quality of life, and prolongs survival. Recently, some studies also demonstrate that noninvasive positive pressure ventilation may offer an alternative to intubation in some patients with COPD and lung edema. Noninvasive ventilatory assistance has benefits compared to ventilatory assistance via intubation if certain safeguards were used. These safeguards include extensive institutional experiences for noninvasive positive pressure ventilations, adequate physicians and respiratory care technicians to provide bedside skilled care and preparedness of emergent intubation, and the patient's mental alertness to tolerate noninvasive ventilatory techniques. The most pronounced benefits of noninvasive positive pressure ventilation was absence of side effects, shortening of time spent in ICU. The present clinical data support the hypothesis that noninvasive positive pressure ventilation may be an alternative for intubation in patient with acute respiratory failure and suggest further clinical investigative support.
患有慢性肺部疾病（慢性阻塞性肺疾病）急性加重、神经肌肉功能障碍和/或通气控制障碍的患者通常需要通气辅助。经气管插管存在医院获得性肺炎和损伤的风险。人们普遍认为，对于慢性肺泡低通气患者，无创正压通气辅助可改善通气、提高生活质量并延长生存期。最近，一些研究还表明，无创正压通气可能为某些慢性阻塞性肺疾病和肺水肿患者提供插管替代方案。如果采取某些保障措施，无创通气辅助与经插管通气辅助相比具有优势。这些保障措施包括丰富的无创正压通气机构经验、有足够的医生和呼吸护理技术人员提供床边熟练护理以及做好紧急插管准备，以及患者的精神警觉性以耐受无创通气技术。无创正压通气最显著的益处是无副作用、缩短在重症监护病房的时间。目前的临床数据支持这样的假设，即无创正压通气可能是急性呼吸衰竭患者插管的替代方案，并建议进一步的临床研究支持。
