Corbetta L, Ballerin L, Putinati S, Potena A
Divisione di Fisiopatologia Respiratoria, Arcispedale S. Anna, Ferrara, Italy.
Monaldi Arch Chest Dis. 1997 Oct;52(5):421-8.
Noninvasive intermittent positive pressure ventilation (NIPPV) via a nasal or facial mask is an effective treatment of hypercapnic acute respiratory failure (ARF) caused by various diseases preventing endotracheal intubation (ETI) in 60-90% of patients. The technique can even be effective for routine care, using simplified ventilators, after adequate personnel training. In this study, the effectiveness, in a general respiratory ward under usual care, of NIPPV delivered by simplified ventilators via facial or nasal mask was evaluated in 40 patients with hypercapnic ARF (NIPPV group) and compared to 30 matched historical patients under conventional treatment (Conv group). Compared to conventional treatment, NIPPV was associated with a reduction in negative events such as ETI and mortality together (17% versus 60%, p = 0.0002), but not mortality alone (5% versus 13.5%, NS) or in the mean (+/- SD) length of the hospital stay (27.31 +/- 16.2 versus 27.5 +/- 20.5 days, NS). Patients treated with NIPPV, but not those treated conventionally, showed significant and rapid changes in arterial carbon dioxide tension (Pa,CO2) and pH between baseline and subsequent evaluation after 6 h, 1, 3 and 7 days and upon the discharge from hospital; in fact, in the NIPPV group after 6 h the arterial pH had risen from 7.30 +/- 0.062 to 7.35 +/- 0.066 and Pa,CO2 had decreased from 9.4 +/- 1.5 to 8.5 +/- 1.1 kPa. In the Conv group pH was stable at 7.29 and Pa,CO2 had risen from 9.39 +/- 1.8 to 9.43 +/- 1.6 kPa. In the NIPPV group no differences were found in the admission characteristics between patients successfully and unsuccessfully ventilated, although a significant improvement was observed after 1 h, for pH from 7.31 +/- 0.058 to 7.36 +/- 0.57 and Pa,CO2 from 9.2 +/- 1.3 to 8.3 +/- 1.3 kPa in successfully ventilated patients. In patients who failed to be ventilated with NIPPV pH worsened, from 7.26 +/- 0.069 to 7.24 +/- 0.078 and Pa,CO2 from 10.0 +/- 2.1 to 11.3 +/- 2.5 kPa. In conclusion, addition of noninvasive positive pressure ventilation delivered by nasal or face mask to conventional therapy, reducing the need for endotracheal intubation, may improve the management of patients with hypercapnic acute respiratory failure as compared to conventional therapy alone, even when instituted in a respiratory ward under usual care with simplified ventilators.
通过鼻罩或面罩进行的无创间歇正压通气（NIPPV）是治疗由各种疾病引起的高碳酸血症急性呼吸衰竭（ARF）的有效方法，可避免60%-90%的患者进行气管插管（ETI）。经过充分的人员培训后，使用简易呼吸机，该技术甚至对常规护理也有效。在本研究中，对40例高碳酸血症ARF患者（NIPPV组）评估了简易呼吸机通过面罩或鼻罩进行NIPPV在普通呼吸病房常规护理中的有效性，并与30例匹配的接受传统治疗的历史患者（Conv组）进行比较。与传统治疗相比，NIPPV与诸如ETI和死亡率等不良事件的减少相关（17%对60%，p = 0.0002），但单独死亡率无差异（5%对13.5%，无统计学意义）或平均（±标准差）住院时间无差异（27.31±16.2对27.5±20.5天，无统计学意义）。接受NIPPV治疗的患者，但接受传统治疗的患者未出现这种情况，在基线与6小时、1天、3天、7天及出院后的后续评估之间，动脉二氧化碳分压（Pa,CO2）和pH值有显著且快速的变化；实际上，在NIPPV组，6小时后动脉pH值从7.30±0.062升至7.35±0.066，Pa,CO2从9.4±1.5降至8.5±1.1kPa。在Conv组，pH值稳定在7.29，Pa,CO2从9.39±1.8升至9.43±1.6kPa。在NIPPV组，成功通气和未成功通气的患者入院特征无差异，尽管在成功通气的患者中，1小时后观察到显著改善，pH值从7.31±0.058升至7.36±0.57，Pa,CO2从9.2±1.3降至8.3±1.3kPa。在未能通过NIPPV通气的患者中，pH值恶化，从7.26±0.069降至7.24±0.078，Pa,CO2从10.0±2.1升至11.3±2.5kPa。总之，与单独的传统治疗相比，在传统治疗基础上加用通过鼻罩或面罩进行的无创正压通气，减少了气管插管的需求，可能改善高碳酸血症急性呼吸衰竭患者的管理，即使是在普通呼吸病房使用简易呼吸机进行常规护理时也是如此。
