Chinese Society of Critical Care Medicine-CSCCM 10th Anniversary

讲座摘要

无创通气：避免失败，改善预后 Non-invasive ventilation: reducing failures and improving outcome

Laurent Brochard

讲座课件

Medical ICU, AP-HP, Albert Chenevier - Henri Mondor Teaching Hospital, Créteil;

Paris 12 University, Créteil ; INSERM unit 955, Créteil, France

Address correspondence to

Pr Laurent Brochard

Service de réanimation médicale

CHU Henri Mondor, 94000 Créteil, France

Tel: +33 1 49 81 23 89 Fax: +33 1 42 07 99 43

E-mail: laurent.brochard@hmn.aphp.fr

Abstract

The use of non-invasive ventilation (NIV) in patients who present with an acute exacerbation of a chronic obstructive pulmonary disease (COPD) is a fundamental pillar in the supportive treatment¹ Nowadays is a routine clinical approach in these acutely ill patients.

The use of NIV is also beneficial for patients with the asphyxic forms of acute cardiogenic pulmonary edema, and as a preventive measure after extubation to avoid the risk of reintubation in at risk patients.

During NIV, pressure support is the most frequently used mode of ventilation, most often in association with PEEP.

In patients with acute exacerbation of COPD it seems there is no identified risk of trying NIV even at a late stage.

Taking more attention to sleep quality of COPD patients treated by NIV may be important for their outcome.

Severe forms of exacerbations associated with hypercapnic coma can be treated with this technique under careful monitoring.

A possible risk of adverse outcome associated with delayed endotracheal intubation in patients who fail a trial of NIV has not been identified in COPD, by contrast to patients with de novo acute respiratory failure².

Future avenues should consider improvements in patient-ventilator interfaces³, reduction in asynchronies through more fefficient algorithm for dealing with leaks⁴, use of helium-oxygen mixtures⁵, and better understanding of late failures, after initial success.

Last, an unresolved but important question concerns the possibility to continue NIV out of the hospital for patients who benefited for an acute treatment with NIV.

References

Brochard L, Mancebo J, Elliott MW: Noninvasive ventilation for acute respiratory failure. Eur Respir J 2002; 19: 712-21

Demoule A, Girou E, Richard JC, Taille S, Brochard L: Benefits and risks of success or failure of noninvasive ventilation. Intensive Care Med 2006; 32: 1756-65

Tarabini Fraticelli A, Lellouche F, L’Her E, Taillé S, Mancebo J, Brochard L: Physiological effects of different interfaces during noninvasive ventilation for acute respiratory failure. Crit Care Med 2008; In press

Vignaux L, Vargas F, Roeseler J, Tassaux D, Thille AW, Kossowsky MP, Brochard L, Jolliet P: Patient-ventilator asynchrony during non-invasive ventilation for acute respiratory failure: a multicenter study. Intensive Care Med 2009; 35: 840-6

Maggiore SM, Richard JC, Abroug F, Diehl JL, Antonelli M, Sauder P, Mancebo J, Ferrer M, Lellouche F, Lecourt L, Beduneau G, Brochard L: A multicenter, randomized trial of noninvasive ventilation with helium-oxygen mixture in exacerbations of chronic obstructive lung disease*. Crit Care Med 2009

第二届中法危重病医学研讨会暨上海重症医学论坛（2009年12月中国上海）