Varon J, Walsh G L, Fromm R E
Baylor College of Medicine, Department of Emergency Services, The Methodist Hospital, Houston, TX 77030, USA.
J Crit Care. 1998 Jun;13(2):55-7. doi: 10.1016/s0883-9441(98)80002-6.
Patients with cancer who require mechanical ventilation have high mortality rates. Although oncological patients have multiple clinical problems, including nutritional and immunological deficiencies, added complications from mechanical ventilation by themselves may be life-threatening and may further compromise the ability of these patients to recover from an episode of acute respiratory failure (ARF). Noninvasive mechanical ventilatory support (NIMV) using positive-pressure-ventilation delivered through a mask has gained popularity for the treatment of ARF and may limit some mechanical ventilation complications. The purpose of this study was to prospectively evaluate NIMV in cancer patients with ARF.
All patients admitted to the surgical intensive care unit (SICU) at The University of Texas M.D. Anderson Cancer Center from August 1, 1994, to April 15, 1996, with hypoxemic or hypercapnic ARF were eligible for this study. NIMV was delivered with the BiPAP S/T-D (Respironics, Murrysville, PA) device. The initial settings were adjusted to achieve a tidal volume of 5 to 7 mL/kg and a SaO2 greater than 0.90. Demographic data, duration of therapy, and need for endotracheal intubation were recorded for each patient.
Sixty patients were included in this study. There were 21 women (35%) and 39 men. The primary cancer sites of these patients were gastrointestinal (25 patients), genitourinary (15), hematological (8), lung (6), sarcoma (4), and skin (2). Fifty-three patients (88%) had hypoxemic ARF and 7 had hypercapnic ARF. The mean duration of NIMV was 1.83 days (range, 1 to 5 days) with a median of 2 days. Forty-two patients (70%) were weaned from NIMV and were spared endotracheal intubation. The remaining 18 patients deteriorated and ultimately required intubation and assisted mechanical ventilation. No complications related to the use of NIMV were seen in this study population.
NIMV was effective in the treatment of ARF in cancer patients at our institution substantially decreasing the need for intubation. This ventilatory technique is a viable option for cancer patients with ARF.
需要机械通气的癌症患者死亡率很高。尽管肿瘤患者存在多种临床问题，包括营养和免疫缺陷，但机械通气本身带来的额外并发症可能危及生命，并可能进一步损害这些患者从急性呼吸衰竭（ARF）发作中恢复的能力。通过面罩进行正压通气的无创机械通气支持（NIMV）在ARF治疗中越来越受欢迎，并且可能会减少一些机械通气并发症。本研究的目的是前瞻性评估NIMV在患有ARF的癌症患者中的应用。
1994年8月1日至1996年4月15日入住德克萨斯大学MD安德森癌症中心外科重症监护病房（SICU）且患有低氧血症或高碳酸血症性ARF的所有患者均符合本研究条件。使用BiPAP S/T-D（Respironics，宾夕法尼亚州默里斯维尔）设备进行NIMV。初始设置进行调整，以实现潮气量为5至7 mL/kg，动脉血氧饱和度（SaO2）大于0.90。记录每位患者的人口统计学数据、治疗持续时间和气管插管需求。
本研究纳入了60例患者。其中有21名女性（35%）和39名男性。这些患者的原发癌部位为胃肠道（25例）、泌尿生殖系统（15例）、血液系统（8例）、肺部（6例）、肉瘤（4例）和皮肤（2例）。53例患者（88%）患有低氧血症性ARF，7例患有高碳酸血症性ARF。NIMV的平均持续时间为1.83天（范围为1至5天），中位数为2天。42例患者（70%）成功撤机，无需气管插管。其余18例患者病情恶化，最终需要插管并接受辅助机械通气。在本研究人群中未观察到与使用NIMV相关的并发症。
在我们机构，NIMV对癌症患者的ARF治疗有效，大大减少了插管需求。这种通气技术是患有ARF的癌症患者的一个可行选择。
