[2023年非侵入性正压通风的临床研究进展]
1State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.
概括
非侵入性正压通风 (NPPV) 对急性呼吸衰竭有好处,特别是在轻度至中度的ARDS和严重呼吸障碍中. 与侵袭性断奶或高流量鼻相比,NPPV也改善了输出管后的结果.
科学领域:
- 肺部和重症监护医学 肺部和重症监护医学
- 呼吸系统疗法 呼吸系统疗法
背景情况:
- 非侵入性正压通风 (NPPV) 是管理急性呼吸衰竭 (ARF) 在各种临床环境中的基石.
- 最近的研究 (2022年10月至2023年9月) 为NPPV的有效性和应用提供了最新的见解.
研究的目的:
- 审查和综合最近关于急性呼吸衰竭的非侵入性正压通风 (NPPV) 的证据.
- 为了将NPPV与其他呼吸辅助方式比较,例如高流量鼻腔管 (HFNC) 和侵入性通风.
- 评估NPPV在特定患者群体和临床场景中的作用,包括COVID-19 ARF和输出管后护理.
主要方法:
- 在2022年10月1日至2023年9月30日期间发表的关于NPPV的Medline索引研究文章的系统审查.
- 对专注于COVID-19和非COVID-19相关的ARF,ARDS严重程度,呼吸障碍和机械通风断奶的研究的分析.
主要成果:
- 与HFNC或常规氧气相比,NPPV对轻度至中度的ARDS和严重呼吸障碍有益,可能减少自我诱导的肺损伤.
- 对于非COVID-19的超性ARF,NPPV和HFNC,死亡率和输管率相似.
- 更新的得分 (HACOR,ROX) 预测了用NPPV治疗的低血量ARF患者的结果.
- 与HFNC相比,立即输出后的NPPV降低了死亡率; 带有活性加湿的NPPV降低了再输入率.
结论:
- 在NPPV和HFNC之间做出选择,应以患者病情的特定病因为指导.
- 在特定的ARF环境中,NPPV表现出显著的优势,包括输出管后支持.
- 需要进一步研究用于CO2清除的非侵入性高频振荡通风.
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