【正文】 CPAP for Thoracoabdominal Aortic Surgery p= 223405101520253035N C P A P C o n t r o lLength of hospital stay(Days) CHEST 2022。 32(2): 8698 “Donotintubate” patients 2022/6/23 79 Conclusion ? NPPV是治療呼吸衰竭的重要有效手段 ? 在 NPPV治療中應(yīng)嚴(yán)密監(jiān)測患者的生命體征，如病情惡化應(yīng)立即氣管插管進(jìn)行有創(chuàng)機(jī)械通氣 ? NPPV的實(shí)施應(yīng)需要 ： ? 有一個(gè)訓(xùn)練有素和富有臨床經(jīng)驗(yàn)的專業(yè)團(tuán)隊(duì) ? 對適應(yīng)癥的選擇應(yīng)慎重 ? NPPV的最終目的是應(yīng)能促進(jìn)患者病情的好轉(zhuǎn) Crit Care 。 Neuromusclar disorders (cont) Eur Respir J. 2022。 [推薦級別： D級 ] ? 無創(chuàng)正壓通氣是 AECOPD患者早期拔管的有效手段。118:203440. Invasive ventilation rate (%) Intubation rate – Early use NIPPV vs. Control 2022/6/23 45 AECOPD (cont) MINERVA ANESTESIOL 2022。359:14251. Conclusions: In patients with ACPE, NIV induces a more rapid improvement in respiratory distress and metabolic disturbance than does standard oxygen therapy , but has no effect on shortterm mortality. ? NIV refers to all modalities that assist ventilation without the use of an endotracheal tube but rather with a sealed facemask. ? NIV with positive endexpiratory pressure (PEEP) should be considered as early as possible in every patient with acute cardiogenic pulmonary oedema and hypertensive AHF as it improves clinical parameters including respiratory distress ? NIV with PEEP improves LV function by reducing LV afterload ? NIV should be used with caution in cardiogenic shock and right ventricular failure 2022/6/23 29 NIV in ACPE (ESC Guideline for Heart failure 2022) European Heart Journal. 2022。18(12 ):706710 ? 預(yù)計(jì)病情能夠短期緩解的早期 ALI/A RDS患者可考慮應(yīng)用NIV。52(5):568 –578. Failure risk charts for NPPV 2022/6/23 8 Interface of NIV J Aerosol Med. 2022。28。344:481487 Immunosuppressed diseases 2022/6/23 38 NIV vs. standard methods for immunosuppressed patients p= 50810102030405060708090N I V S t a n d a r dDeath rates in hospital (%) N Engl J Med. 2022。 8 Control 43 177。 32(2): 8698 Severe COPD in stable stage (cont) 2022/6/23 58 Asthma ? 對部分以單純以低氧血癥為主的重癥哮喘患者單純應(yīng)用CPAP即可以有效緩解呼吸肌疲勞、改善氧合，而應(yīng)用BiPAP治療可以迅速緩解呼吸窘迫狀況，促進(jìn)二氧化碳排出、改善呼吸功能 ? 但是由于缺乏大樣本的研究，尚無證據(jù)證明 NIPPV能夠降低重癥哮喘的氣管插管率和病死率，應(yīng)用 NIPPV需嚴(yán)密監(jiān)測患者生命體征變化，必要時(shí)立即行氣管插管 Cochrane Database Syst Rev. 2022。52(11):1472–1479. It appears to be promising as a prophylaxis to prevent reintubation in patients “at risk” for developing postextubation respiratory failure 2022/6/23 72 “Donotintubate” patients NPPV對那些疾病晚期但是拒絕氣管插管的患者來說是一種有效的姑息治療手段，可以在一定時(shí)期內(nèi)部分緩解呼吸窘迫，維持患者的生命體征平穩(wěn)，延長生命 Crit Care Med 2022。 32(2): 8698 “Donotintubate” patients ? 對于拒絕氣管插管的呼吸衰竭患者， NPPV可以作為一種有效的替代治療措施 2022/6/23 74 Conclusion CHEST 2022。 32(2): 8698 Asthma 2022/6/23 60 Hypoventilation, OSAHS amp。 12 7 16177。 28:1233–1238 ICU p= 10 20 30 40 60 80 NIV Traditional 2 months p= 6 months p= Survival rates (%) 75% 38% 58% 21% 25% 16% NIV for AIDS patients with with pneumocystis carinii pneumonia 70 50 Immunosuppressed diseases 2022/6/23 40 Immunosuppressed diseases ?The reduced mortality is likely related to reduced infectious plications associated with