Corrado A, Gorini M, Ginanni R, Pelagatti C, Villella G, Buoncristiano U, Guidi F, Pagni E, Peris A, De Paola E
Dipartimento di Pneumologia, Villa di Ognissanti, Ospedale di Careggi, Firenze, Italy.
Eur Respir J. 1998 Sep;12(3):519-25. doi: 10.1183/09031936.98.12030519.
This case-control study was aimed to evaluate the effectiveness of negative pressure ventilation (NPV) versus conventional mechanical ventilation (CMV) for the treatment of acute respiratory failure (ARF) in patients with chronic obstructive pulmonary disease (COPD) admitted to a respiratory intermediate intensive care unit (RIICU) and four general intensive care units (ICU). Twenty-six COPD patients in ARF admitted in 1994-95 to RIICU and treated with NPV (cases) were matched according to age (+/-5 yrs), sex, causes triggering ARF, Acute Physiology and Chronic Health Evaluation (APACHE) II score (+/- 5 points), pH (+/-0.05) and arterial carbon dioxide tension (Pa,CO2) on admission with 26 patients admitted to ICU and treated with CMV (controls). The primary end points of the study were inhospital death for both groups and the need for endotracheal intubation for cases. The secondary endpoints were length and complications of mechanical ventilation and length of hospital stay. The effectiveness of matching was 91%. Mortality rate was 23% for cases and 27% for controls (NS), five cases needed endotracheal intubation, four of whom subsequently died. The duration of ventilation in survivors was significantly lower in cases than in controls, with a median of 16 h (range 2-111) versus 96 h (range 12-336) (P<0.02), whereas the length of hospital stay was similar in the two groups, with a median of 12 days (range 2-47) for cases vs 12 days (range 3-43) (NS) for controls. No complications were observed in cases, whereas three controls developed infective complications. These results suggest that negative pressure ventilation is as efficacious as conventional mechanical ventilation for the treatment of acute respiratory failure in patients with chronic obstructive pulmonary disease and that it is associated with a shorter duration of ventilation and a similar length of hospital stay compared with conventional mechanical ventilation.
本病例对照研究旨在评估负压通气（NPV）与传统机械通气（CMV）在治疗入住呼吸中级重症监护病房（RIICU）和四个普通重症监护病房（ICU）的慢性阻塞性肺疾病（COPD）患者急性呼吸衰竭（ARF）方面的有效性。1994年至1995年入住RIICU并接受NPV治疗的26例ARF的COPD患者（病例组），根据年龄（±5岁）、性别、引发ARF的原因、急性生理与慢性健康状况评分系统（APACHE）II评分（±5分）、入院时的pH值（±0.05）和动脉二氧化碳分压（PaCO₂）与入住ICU并接受CMV治疗的26例患者（对照组）进行匹配。该研究的主要终点是两组的院内死亡情况以及病例组的气管插管需求。次要终点是机械通气的时长和并发症以及住院时间。匹配的有效性为91%。病例组的死亡率为23%，对照组为27%（无统计学差异），5例病例需要气管插管，其中4例随后死亡。存活者的通气时长病例组显著低于对照组，中位数为16小时（范围2 - 111小时），而对照组为96小时（范围12 - 336小时）（P<0.02），而两组的住院时间相似，病例组中位数为12天（范围2 - 47天），对照组为12天（范围3 - 43天）（无统计学差异）。病例组未观察到并发症，而3例对照组出现感染性并发症。这些结果表明，负压通气在治疗慢性阻塞性肺疾病患者的急性呼吸衰竭方面与传统机械通气同样有效，并且与传统机械通气相比，其通气时长更短，住院时间相似。
