无创压力支持通气序贯用于慢性阻塞性肺疾病急性加重期

Sequential use of noninvasive pressure support ventilation for acute exacerbations of COPD.

作者信息

Hilbert G, Gruson D, Gbikpi-Benissan G, Cardinaud J P

机构信息

Service de Réanimation Médicale B, Hôpital Pellegrin, Bordeaux, France.

出版信息

Intensive Care Med. 1997 Sep;23(9):955-61. doi: 10.1007/s001340050438.

DOI:10.1007/s001340050438

PMID:9347367

Abstract

OBJECTIVES

To compare the efficacy of noninvasive pressure support ventilation (NIPSV) in acute decompensation in chronic obstructive pulmonary disease (COPD) by means of a bi-level positive airway pressure support system (BiPAP) in a sequential mode with medical therapy alone; to assess the short-term physiologic effects of the device on gas exchange; and to compare patients successfully ventilated with NIPSV with those in whom NIPSV failed.

DESIGN

A prospective case series with historically matched control study.

SETTING

A general intensive care unit (ICU) of a university hospital.

PATIENTS

We evaluated the efficacy of administration of NIPSV in 42 COPD patients and compared this with standard treatment in 42 matched historical control COPD patients.

INTERVENTIONS

NIPSV was performed in a sequential mode, i.e., BiPAP in the spontaneous mode was used for at least 30 min every 3 h. Between periods of ventilation, patients could be systematically returned to BiPAP when the arterial oxygen saturation was < 0.85 or when the respiratory rate was > 30 breaths/min.

MEASUREMENTS AND RESULTS

Success rate, mortality, duration of ventilatory assistance, and length of ICU stay were recorded. Eleven of the 42 patients (26%) in the NIPSV group needed tracheal intubation compared with 30 of the 42 control patients (71%). The 31 patients in whom NIPSV was successful were ventilated for a mean of 6 +/- 3 days. In-hospital mortality was not significantly different in the treated versus the control group, but the duration of ventilatory assistance (7 +/- 4 days vs 15 +/- 10 days, p < 0.01) and the length of ICU stay (9 +/- 4 days vs 21 +/- 12, p < 0.01) were both shortened by NIPSV. BiPAP was effective in correcting gas exchange abnormalities. The pH values, measured after 45 min of BiPAP with optimal settings, in the success (7.38 +/- 0.04) and failure (7.28 +/- 0.04) patients were significantly different (p < 0.05).

CONCLUSIONS

NIPSV, performed with a sequential mode, may be used in the management of patients with acute exacerbations of COPD.

摘要

目的

通过双水平气道正压支持系统（BiPAP）以序贯模式联合单纯药物治疗，比较无创压力支持通气（NIPSV）对慢性阻塞性肺疾病（COPD）急性失代偿的疗效；评估该设备对气体交换的短期生理效应；并比较NIPSV通气成功的患者与NIPSV失败的患者。

设计

一项具有历史对照匹配研究的前瞻性病例系列研究。

设置

一所大学医院的综合重症监护病房（ICU）。

患者

我们评估了42例COPD患者应用NIPSV的疗效，并将其与42例匹配的历史对照COPD患者的标准治疗进行比较。

干预措施

NIPSV以序贯模式进行，即每3小时使用自主模式的BiPAP至少30分钟。在通气期间，当动脉血氧饱和度<0.85或呼吸频率>30次/分钟时，患者可系统地恢复使用BiPAP。

测量和结果

记录成功率、死亡率、通气辅助持续时间和ICU住院时间。NIPSV组42例患者中有11例（26%）需要气管插管，而对照组42例患者中有30例（71%）需要气管插管。NIPSV成功的31例患者平均通气6±3天。治疗组与对照组的院内死亡率无显著差异，但NIPSV缩短了通气辅助持续时间（7±4天对15±10天，p<0.01）和ICU住院时间（9±4天对21±12天，p<0.01）。BiPAP对纠正气体交换异常有效。在设置最佳参数的BiPAP治疗45分钟后，成功（7.38±0.04）和失败（7.28±0.04）患者的pH值有显著差异（p<0.05）。