Rabec C, Merati M, Baudouin N, Foucher P, Ulukavac T, Reybet-Degat O
Service de Pneumologie et Réanimation Respiratoire, CHU, Dijon.
Rev Mal Respir. 1998 Jun;15(3):269-78.
Obstructive Sleep Apnea (OSA), Obesity-Linked Hypoventilation (OLH)--a hypoventilation which is independent of apneas and increased by sleep--, and COPD are mechanisms for respiratory failure in obese patients. We thought nasal bi-level positive airway pressure to be a suitable treatment: EPAP is useful to maintain upper airway patency and IPAP-EPAP difference to correct OLH and COPD hypoventilation. Our purpose is to report the results of such a therapeutic approach. We included 41 patients that we first treated by nasal bi-level positive airway pressure for a respiratory failure with an uncompensated respiratory acidosis. The initial setting was about 4 cm H2O for EPAP and 16 for IPAP. Under supervision of a real-time printed oximetry tracing, we furthermore increased EPAP until disappearance of repetitive dips in oxygen saturation (that we assimilated to obstructive events) and IPAP until obtaining an acceptable level of steady saturation (we assimilated a low level to a steady hypoventilation). Age (mean +/- SD) was 63 +/- 11 years, BMI 42 +/- 9 kg/m2, pH 7.32 +/- 0.04, PaCO2 71 +/- 13 mmHg, PaO2 45 +/- 7 mmHg. Thirty-nine out of 41 patients returned home without need for tracheal intubation. At 7 days of treatment, PaCO2 was 50 +/- 6 mmHg. Thus, nasal bi-level position airway pressure appears to be an efficient treatment in these patients.
阻塞性睡眠呼吸暂停（OSA）、肥胖相关通气不足（OLH）——一种独立于呼吸暂停且在睡眠时加重的通气不足——以及慢性阻塞性肺疾病（COPD）是肥胖患者呼吸衰竭的机制。我们认为经鼻双水平气道正压通气是一种合适的治疗方法：呼气末正压（EPAP）有助于维持上气道通畅，吸气压力（IPAP）与呼气末正压的差值可纠正OLH和COPD通气不足。我们的目的是报告这种治疗方法的结果。我们纳入了41例因呼吸衰竭伴失代偿性呼吸性酸中毒而首先接受经鼻双水平气道正压通气治疗的患者。初始设置为EPAP约4 cmH₂O，IPAP为16 cmH₂O。在实时打印的血氧饱和度监测下，我们进一步增加EPAP直至氧饱和度反复下降消失（我们将其视为阻塞性事件），并增加IPAP直至获得可接受的稳定饱和度水平（我们将低水平视为持续性通气不足）。年龄（均值±标准差）为63±11岁，体重指数（BMI）为42±9 kg/m²，pH值为7.32±0.04，动脉血二氧化碳分压（PaCO₂）为71±13 mmHg，动脉血氧分压（PaO₂）为45±7 mmHg。41例患者中有39例无需气管插管即可回家。治疗7天时，PaCO₂为50±6 mmHg。因此，经鼻双水平气道正压通气似乎是这些患者的一种有效治疗方法。
