Celikel T, Sungur M, Ceyhan B, Karakurt S
Department of Pulmonary and Critical Care Medicine, Marmara University Hospital, Istanbul, Turkey.
Chest. 1998 Dec;114(6):1636-42. doi: 10.1378/chest.114.6.1636.
To compare the efficacy of standard medical therapy (ST) and noninvasive mechanical ventilation additional to standard medical therapy in hypercapnic acute respiratory failure (HARF).
Single center, prospective, randomized, controlled study.
Pulmonary medicine directed critical care unit in a university hospital.
Between March 1993 and November 1996, 30 HARF patients were randomized to receive ST or noninvasive positive pressure ventilation (NPPV) in addition to ST.
NPPV was given with an air-cushioned face via a mechanical ventilator (Puritan Bennett 7200) with initial setting of 5 cm H2O continuous positive airway pressure and 15 cm H2O pressure support.
At the time of randomization, patients in the ST group had (mean+/-SD) PaO2 of 54+/-13 mm Hg, PaCO2 of 67+/-11 mm Hg, pH of 7.28+/-0.02, and respiratory rate of 35.0+/-5.8 breaths/min. Patients in the NPPV group had PaO2 of 55+/-14, PaCO2 of 69+/-15, pH of 7.27+/-0.07, and respiratory rate of 34.0+/-8.1 breaths/min. With ST, there was significant improvement of only respiratory rate (p < 0.05). However, with NPPV, PaO2 (p < 0.001), PaCO2 (p < 0.001), pH (p < 0.001), and respiratory rate (p < 0.001) improved significantly compared with baseline. Six hours after randomization, pH (p < 0.01) and respiratory rate (p < 0.01) in NPPV patients were significantly better than with ST. Hospital stay for NPPV vs ST patients was, respectively, 11.7+/-3.5 and 14.6+/-4.7 days (p < 0.05). One patient in the NPPV group required invasive mechanical ventilation. The conditions of six patients in the ST group deteriorated and they were switched to NPPV; this was successful in four patients, two failures were invasively ventilated.
This study suggests that early application of NPPV in HARF patients facilitates improvement, decreases need for invasive mechanical ventilation, and decreases the duration of hospitalization.
比较标准药物治疗（ST）与标准药物治疗联合无创机械通气在高碳酸血症急性呼吸衰竭（HARF）中的疗效。
单中心、前瞻性、随机对照研究。
大学医院的肺科重症监护病房。
1993年3月至1996年11月期间，30例HARF患者被随机分为接受ST治疗组或接受ST联合无创正压通气（NPPV）治疗组。
通过机械通气机（伟康7200）经气垫面罩给予NPPV，初始设置为气道持续正压5 cm H2O和压力支持15 cm H2O。
随机分组时，ST组患者的（均值±标准差）动脉血氧分压（PaO2）为54±13 mmHg，动脉血二氧化碳分压（PaCO2）为67±11 mmHg，pH值为7.28±0.02，呼吸频率为35.0±5.8次/分钟。NPPV组患者的PaO2为55±14，PaCO2为69±15，pH值为7.27±0.07，呼吸频率为34.0±8.1次/分钟。采用ST治疗时，仅呼吸频率有显著改善（p<0.05）。然而，采用NPPV治疗时，与基线相比，PaO2（p<0.001）、PaCO2（p<0.001）、pH值（p<0.001）和呼吸频率（p<0.001）均有显著改善。随机分组6小时后，NPPV组患者的pH值（p<0.01）和呼吸频率（p<0.01）明显优于ST组。NPPV组和ST组患者的住院时间分别为11.7±3.5天和14.6±4.7天（p<0.05）。NPPV组有1例患者需要有创机械通气。ST组有6例患者病情恶化，转而接受NPPV治疗；其中4例成功，2例失败后接受有创通气。
本研究表明，早期对HARF患者应用NPPV有助于病情改善，减少有创机械通气需求，并缩短住院时间。
