在社区获得的严重肺炎:非侵入性机械通风,输管和HFNT
Miquel Ferrer1,2,3, Gennaro De Pascale4,5, Eloisa S Tanzarella4,5
1Unitat de Vigilancia Intensiva Respiratoria, Servei de Pneumologia, Hospital Clinic de Barcelona, Institut d'Investigacions Biomediques August Pi I Sunyer (IDIBAPS), Barcelona, Spain.
Seminars in respiratory and critical care medicine
|April 11, 2024
概括
高流鼻疗法 (HFNT) 和非侵入性通风 (NIV) 有助于管理社区获得性肺炎 (CAP) 中的严重急性呼吸衰竭 (ARF). 临床医生的判断指导HFNT和NIV之间的选择,以获得最佳的患者结果.
科学领域:
- 关键护理医学 关键护理医学
- 肺部病理学 肺部病理学
- 传染性疾病 传染性疾病
背景情况:
- 严重急性呼吸衰竭 (ARF) 是社区获得性肺炎 (CAP) 的关键并发症.
- 标准的氧气治疗对于严重的ARF是不够的,需要先进的呼吸支持.
- 非侵入性策略弥合了标准氧气和侵入性机械通风 (IMV) 之间的差距.
研究的目的:
- 为了探索最优的非侵入性呼吸支策略,严重的CAP患者ARF.
- 根据患者特定的因素,指导选择高流量鼻腔治疗 (HFNT) 与非侵入性通风 (NIV).
- 在严重的CAP中为管理ARF的临床决策提供信息.
主要方法:
- 审查当前的证据和临床指导方针对严重的CAP中ARF管理.
- 讨论HFNT和NIV的作用和适应情况.
- 考虑NIV的禁忌和患者选择标准.
- 在必要时应用急性呼吸窘迫综合征 (ARDS) 保护性通风策略对IMV.
主要成果:
- 在严重的CAP中,HFNT通常是ARF的初始方法.
- 尽管存在潜在的禁忌,但NIV可能更适合患有呼吸工作增加或某些血液动力学疾病的患者.
- 精心选择患者和密切监测对于NIV试验至关重要.
- 对于严重的CAP患者,建议采用保护性IMV策略,因为有限的具体数据,需要侵入性支持.
结论:
- 在严重的CAP相关的ARF中优化呼吸支需要个性化评估.
- HFNT和NIV提供了有价值的非侵入性选择,患者的特征指导了选择.
- 当非侵入性方法失败或禁用时,迅速升级到IMV和应用保护性通风策略至关重要.
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