机械通气的变化课件

机械通气的变化机械通气的变化1讨论的问题历史回顾机械通气的流行病学调查循证医学与机械通气的变化总结讨论的问题历史回顾2机械通气的变化课件3机械通气的变化课件4机械通气的变化课件5历史回顾-ThefirstICUintheworldKommunehospitaletinCopenhagen.Thehospitalwasinauguratedin1863.Thestudentnurses’TurnedintotheworldsfirstICUwasonthefirstfloorActaAnaesthesiolScand2003;47:1190-1195历史回顾-ThefirstICUintheworl6历史回顾-ThefirstICUintheworldBjornIbsen(1915-).InitiatorOfthefirstmultidisciplinaryICUIn1951hereceivedehisspecialistdiplomaInanesthesiology.TheturningPointinhiscareercamewhenHebecameinvolvedinthetreatmentOfthemostseverelyillvictimsOfthe1952poliomyelitisoutbreakInDenmarkActaAnaesthesiolScand2003;47:1190-1195历史回顾-ThefirstICUintheworl7Patientno.1December21st,19536.00p.m:A43year-old-manwasadmittedfromthemedicalwardtotheObservationRoom,threedaysafterhehadattemptedtohanghimself.Hewasagitated,confusedandcyanoticwithlabouredrespiration.T38.6C,pulse136.AnX-rayshowedbilateralinfiltratedandoedemaofthelung.OxygenviafacemaskandwhentheSaO2decreased,withpositivepressureventilationfrombagandmask,wasstarted.历史回顾

ActaAnaesthesiolScand2003;47:1190-1195Patientno.1历史回顾

ActaAnaesth8December22nd

7.15a.m:Theconditionofthepatienthaddeteriorated.Atubewithcuffwaspassedintohistracheaandmanualpositiveventilationwith60%oxygeninN2Owasstarted.00.45p.m:SaO280%,Increasesto86%when100%oxygenwasusedinsteadoftheO2/N2Omixture3.00p.m:ABGpH7.51,pCO231mmHg,SaO2100%.Clinicallythepatientwasmuchimproved.Therespirationwassufficientandhewasextubated.历史回顾ActaAnaesthesiolScand2003;47:1190-1195December22nd历史回顾ActaAnaesth9历史回顾BjornIbsen第一次使用正压通气治疗呼吸衰竭的医生（InthefirstICUintheworld）这项新技术的应用使脊髓灰质炎的病死率从1952.7的87%下降到1953.3的15%因此1953年3月是机械通气的生日ActaAnaesthesiolScand2003;47:1190-1195历史回顾BjornIbsen第一次使用正压通气治疗呼吸衰竭10历史回顾历史回顾11机械通的流行病学第一个机械通气流行病学的报告是Rogers1972发表的Chest1972；62：94-97机械通的流行病学第一个机械通气流行病学的报告是Rogers12ImpactoftheRespiratoryIntensiveCareUnitonSurvivalofPatientswithAcuteRespiratoryFailure持续机械通气患者病死率的比较（1965-1968普通病房vs1969onRICU)Chest1972；62：94-97ImpactoftheRespiratoryInte13

ConclusionAdramaticreductioninmortalityfromARFhasbeenachievedwhenthesepatientsweretreatedinaunitwithspeciallytrainedphysicians,nursesandauxiliarypersonnelAvailabilityofaccuratemonitoring,inhalationandphysicaltherapyontheunitInteractionofthephysicians,nursesandtechniciansfromtheunitwithothermembersofhospitalstaffhasraisedthelevelofrespiratorycarefortheentireinstitutionImpactoftheRespiratoryIntensiveCareUnitonSurvivalofPatientswithAcuteRespiratoryFailureChest1972；62：94-97ConclusionImpa14ModesofMechanicalVentilationandWeaning-ANationalSurveyofSpanishHospital

1992.1Esdeban对西班牙47个ICU机械通气模式和脱机方法进行了调查，290名病人机械通气时间大于24小时

Chest1994;106:1188-1193ModesofMechanicalVentilatio15ModesofMechanicalVentilationandWeaning-ANationalSurveyofSpanishHospitalChest1994;106:1188-1193呼吸机可提供的模式病人应用的模式ModesofMechanicalVentilatio16ModesofMechanicalVentilationandWeaning-ANationalSurveyofSpanishHospital病人机械通气的天数Chest1994;106:1188-1193ModesofMechanicalVentilatio17ModesofMechanicalVentilationandWeaning-ANationalSurveyofSpanishHospital脱机模式与成功率T-piece最好SIMVPSSIMV+PSChest1994;106:1188-1193ModesofMechanicalVentilatio18HowistheMechanicalVentilationEmployedinICU？1996.11-1997.1Esteban主持8个国家412个ICU参加的机械通气流行病学调查共有4153住ICU病人，其中1638名机械通气（39%）AmJRespirCritCareMed2000;106:1450-1458HowistheMechanicalVentilat19HowistheMechanicalVentilationEmployedinICU？人工气道的选择（8个国家）AmJRespirCritCareMed2000;106:1450-1458HowistheMechanicalVentilat20HowistheMechanicalVentilationEmployedinICU？机械通气选择的模式脱机选择的模式

AmJRespirCritCareMed2000;106:1450-1458HowistheMechanicalVentilat21HowistheMechanicalVentilationEmployedinICU？A/C和PSV时呼吸机参数的设定AmJRespirCritCareMed2000;106:1450-1458HowistheMechanicalVentilat22HowistheMechanicalVentilationEmployedinICU？PEEP的设定AmJRespirCritCareMed2000;106:1450-1458HowistheMechanicalVentilat23HowistheMechanicalVentilationEmployedinICU？Insummary:机械通气模式多种多样，90%机械通气病人使用A/CorPSorPS+SIMVVt的选择通常是7-10ml/kgPEEP的选择多为5cmH2OSIMV和某些新的通气模式很少使用（允许性高碳酸症通气，无创通气）脱机的方式多种多样，使用SBT的不多AmJRespirCritCareMed2000;106:1450-1458HowistheMechanicalVentilat24MechanicalVentilationinOntaroio;1992-2000回顾性，队列调查研究1992-2000Ontario州住院病人资料库150755名非心脏手术病人，接受机械通气

CritCareMed2004；32：1504-1509MechanicalVentilationinOnta25MechanicalVentilationinOntaroio;1992-2000

92939495969798992000Change%MVPatient

15989161081696417303176861801718785196091938820MVper10,0000population20019920720821021121722321712InpatientBedday839479757452713867136239620961586199-26MVdaysPer10,0000Population868278170190392964349551810172410739411157310903026Mortality30day272829303131333332p<0.001MechanicalVentilationinOnta26CharacteristicsandOutcomesinAdultPatientsReceivingMechanicalVentilation-A

28-DayinternationalStudy多中心、前瞻性的队列研究20个国家，361个ICU，98.3.1-98.3.31共15757病人收入ICU，5183病人机械通气>12小时，观察28天平均机械通气时间5.9天平均ICU住院11.2天

JAMA，2002；287：345-355CharacteristicsandOutcomesi27CharacteristicsandOutcomesinAdultPatientsReceivingMechanicalVentilation-A

28-DayinternationalStudyCOPD&ARDS机械通气的模式（1.3.7天）COPDARDS

day1day3day7day1day3day7

(n=522)(n=283)(n=85)(n=231)(n=174)(n=82)MVModesNo(%)A/C344(65.9)180(63.6)57(67.1)165(67)111(63.8)50(61)SIMV/PS50(9.6)32(11.3)9(10.6)24(10.4)20(11.5)8(9.8)PS40(7.6)24(8.5)10(11.8)3(1.4)6(3.4)3(3.7)PCV20(3.9)11(3.9)2(2.4)24(10.4)23(13.2)13(15.9)SIMV24(4.6)10(3.5)2(2.4)10(4.2)4(2.3)2(2.4)JAMA，2002；287：345-355CharacteristicsandOutcomesi28CharacteristicsandOutcomesinAdultPatientsReceivingMechanicalVentilation-A

28-DayinternationalStudyCOPDARDSJAMA，2002；287：345-355CharacteristicsandOutcomesi29CharacteristicsandOutcomesinAdultPatientsReceivingMechanicalVentilation-A

28-DayinternationalStudy

JAMA，2002；287：345-355机械通气时间与存活率的关系CharacteristicsandOutcomesi30CharacteristicsandOutcomesinAdultPatientsReceivingMechanicalVentilation-A

28-DayinternationalStudy每日机械通气模式的变化JAMA，2002；287：345-355CharacteristicsandOutcomesi31TheChangingEpidemiologyofMechanicalVentilation:APopulation-basedStudy

JournalofIntensiveCareMed200621(3):173-1821996-2002回顾性调查研究，北卡罗来那州出院病人资料库，ICD-9修订版的诊断标准1996年机械通气病人285/10万，2002增加为314/10万，增加11%（p<0.05)TheChangingEpidemiologyofM32TheChangingEpidemiologyofMechanicalVentilation:APopulation-basedStudy

JournalofIntensiveCareMed200621(3):173-182机械通气病人合并肾脏病明显增加（96年17%vs02年24%）肾病TheChangingEpidemiologyofM33TheChangingEpidemiologyofMechanicalVentilation:APopulation-basedStudy

JournalofIntensiveCareMed200621(3):173-182机械通气病人医疗消费指数（CPI）增长12%TheChangingEpidemiologyofM34TheChangingEpidemiologyofMechanicalVentilation:APopulation-basedStudy

JournalofIntensiveCareMed200621(3):173-182出院病人回家45.5%下降到34.4%,回到NursingHome从7.3%增加到10.7%，回家的人越来越少TheChangingEpidemiologyofM35EvolutionofMechanicalVentilationinResponsetoClinicalResearch

多中心、前瞻性、队列研究23个国家，349个ICU4968名机械通气的病人入选对107个ICU中1675名病人与1998年1383名病人临床资料进行比较2004与1998临床使用机械通的变化

AmJRespirCritCareMed2008;177:170-177EvolutionofMechanicalVentil36EvolutionofMechanicalVentilationinResponsetoClinicalResearch

2004vs1998推测发生的变化？Noninvasivepositive-pressureventilation

IncreaseduseofNPPVforCOPDIncreaseduseofNPPVforAcutehypoxemicrespiratoryfailureARDSDecreasedtidalvolumesMinimalincreaseinlevelsofPEEPNochangeintheuseofpressure-controlmodesNochangeintheuseofpronepositionWeaningfrommechanicalventilationIncreaseduseofPSversusT-pieceinspontaneousbreathingtrialsIncreaseduseofspontaneousbreathingtrialstoassessextubationreadinessDecreaseduseofSIMVasamethodforgraduallyreducingventilationsupportIncreaseduseofPSasamethodforgraduallyreducingventilationsupportNosignificantchangeintracheostomyuuseortimingEvolutionofMechanicalVentil37EvolutionofMechanicalVentilationinResponsetoClinicalResearch

NPPV病人2004与1998的比较AmJRespirCritCareMed2008;177:170-177EvolutionofMechanicalVentil38NPPVNPPV的临床应用2004明显增加，包括COPD和ARFNPPV的时间增加（2vs3d,p=0.03)气管插管率和无明显变化。但NPPV成功的病人病死率有下降（20%vs10%，p=0.08)EvolutionofMechanicalVentilationinResponsetoClinicalResearch

AmJRespirCritCareMed2008;177:170-177NPPVEvolutionofMechanicalVe39EvolutionofMechanicalVentilationinResponsetoClinicalResearch

ARDS病人的特点2004与1998的比较AmJRespirCritCareMed2008;177:170-177EvolutionofMechanicalVentil40ARDSVt的临床使用明显减少（2004年Vt超过10ml/kg7.5vs29.6%.p<0.001,小于6ml/kg增加19.6vs4.4%，p<0.001)2004年使用限制压力/容量通气策略明显增加2004年PEEP水平明显增加(PEEP>10cmH2O40%vs20%)Volumeassist-control仍是ARDS患者最常用机械通气模式，每1000个ARDS日，1998年A/C占548天，2004年占504天PCV模式，每1000个ARDS日，1998年占244天，2004年占202天俯卧位通气减少（2004，7%。1998，13%）病死率无变化EvolutionofMechanicalVentilationinResponsetoClinicalResearch

ARDSEvolutionofMechanicalV41脱机共有1649名计划性脱机的患者，拔管前做SBT1998年58%，2004年62%p=0.09，SBT有增加的趋势SBT成功后拔管的比列明显增加（62%vs77%p<0.001)T-piece是最常用SBT（1998年76%，2004年71%，p=0.07)但低水平PS用于SBT有增加的趋势（10vs14%p=0.06)第一次SBT后未能拔管的病人中使用SIMV和SIMV+PS明显减少(11vs1.6%p<0.001)和(26%vs15%,p<0.001)，使用PSV明显增加（19vs55%,p<0.001)EvolutionofMechanicalVentilationinResponsetoClinicalResearch

脱机EvolutionofMechanicalVent42EvolutionofMechanicalVentilationinResponsetoClinicalResearch

Insummary:本研究描述了机械通气的现状、变化和病人的预后研究表明临床机械通气的行为已经发生了变化（ARDS、NPPV、Weaning）机械通气的病死率变化不大AmJRespirCritCareMed2008;177:170-177EvolutionofMechanicalVentil43ProlongedAcuteMechanicalVentilation,hospitalresourceutilization,andmortalityinUnitedStates

多中心、横断面调查2003年美国出院的成年患者。机械通气>96小时为长期急性机械通气（ProlongedAcuteMV,PAMV),按ICD-996.70-96.72

CritCareMed2008；36：724-730ProlongedAcuteMechanicalVen44ProlongedAcuteMechanicalVentilation,hospitalresourceutilization,andmortalityinUnitedStates

31340578出院患者2.4%onMV469168(61%)MV<96day294333(39%)PAMVCritCareMed2008；36：724-730ProlongedAcuteMechanicalVen45ProlongedAcuteMechanicalVentilation,hospitalresourceutilization,andmortalityinUnitedStatesCritCareMed2008；36：724-730ProlongedAcuteMechanicalVen46ProlongedAcuteMechanicalVentilation,hospitalresourceutilization,andmortalityinUnitedStates结论2003年美国有近30万PAMV患者每年消耗160亿美金占全部机械通气的2/3CritCareMed2008；36：724-730ProlongedAcuteMechanicalVen47小结机械通气的变化1.ARDSVt减小、PEEP增加、HFPV增加,NPPV增加2.COPDNPPV增加3.WeaningSBT增加，SIMV减少机械通气的模式无变化，最常用的仍为A/C，SIMV，PS机械通气的改变改善了病人的预后，但PAMV的病人明显增多，消耗大量资源，如何应对？小结机械通气的变化48总结由于多个RCT研究的不断发表，我们看到机械通气发生悄悄的变化这些变化也反映了机械通气的发展趋势这些变化改变了病人的预后，缩短了机械通的时间机械通气的病人明显增加，长时间依赖MV增多，这些病人如何管理？总结由于多个RCT研究的不断发表，我们看到机械通气发生悄悄的49机械通气的变化机械通气的变化50讨论的问题历史回顾机械通气的流行病学调查循证医学与机械通气的变化总结讨论的问题历史回顾51机械通气的变化课件52机械通气的变化课件53机械通气的变化课件54历史回顾-ThefirstICUintheworldKommunehospitaletinCopenhagen.Thehospitalwasinauguratedin1863.Thestudentnurses’TurnedintotheworldsfirstICUwasonthefirstfloorActaAnaesthesiolScand2003;47:1190-1195历史回顾-ThefirstICUintheworl55历史回顾-ThefirstICUintheworldBjornIbsen(1915-).InitiatorOfthefirstmultidisciplinaryICUIn1951hereceivedehisspecialistdiplomaInanesthesiology.TheturningPointinhiscareercamewhenHebecameinvolvedinthetreatmentOfthemostseverelyillvictimsOfthe1952poliomyelitisoutbreakInDenmarkActaAnaesthesiolScand2003;47:1190-1195历史回顾-ThefirstICUintheworl56Patientno.1December21st,19536.00p.m:A43year-old-manwasadmittedfromthemedicalwardtotheObservationRoom,threedaysafterhehadattemptedtohanghimself.Hewasagitated,confusedandcyanoticwithlabouredrespiration.T38.6C,pulse136.AnX-rayshowedbilateralinfiltratedandoedemaofthelung.OxygenviafacemaskandwhentheSaO2decreased,withpositivepressureventilationfrombagandmask,wasstarted.历史回顾

ActaAnaesthesiolScand2003;47:1190-1195Patientno.1历史回顾

ActaAnaesth57December22nd

7.15a.m:Theconditionofthepatienthaddeteriorated.Atubewithcuffwaspassedintohistracheaandmanualpositiveventilationwith60%oxygeninN2Owasstarted.00.45p.m:SaO280%,Increasesto86%when100%oxygenwasusedinsteadoftheO2/N2Omixture3.00p.m:ABGpH7.51,pCO231mmHg,SaO2100%.Clinicallythepatientwasmuchimproved.Therespirationwassufficientandhewasextubated.历史回顾ActaAnaesthesiolScand2003;47:1190-1195December22nd历史回顾ActaAnaesth58历史回顾BjornIbsen第一次使用正压通气治疗呼吸衰竭的医生（InthefirstICUintheworld）这项新技术的应用使脊髓灰质炎的病死率从1952.7的87%下降到1953.3的15%因此1953年3月是机械通气的生日ActaAnaesthesiolScand2003;47:1190-1195历史回顾BjornIbsen第一次使用正压通气治疗呼吸衰竭59历史回顾历史回顾60机械通的流行病学第一个机械通气流行病学的报告是Rogers1972发表的Chest1972；62：94-97机械通的流行病学第一个机械通气流行病学的报告是Rogers61ImpactoftheRespiratoryIntensiveCareUnitonSurvivalofPatientswithAcuteRespiratoryFailure持续机械通气患者病死率的比较（1965-1968普通病房vs1969onRICU)Chest1972；62：94-97ImpactoftheRespiratoryInte62

ConclusionAdramaticreductioninmortalityfromARFhasbeenachievedwhenthesepatientsweretreatedinaunitwithspeciallytrainedphysicians,nursesandauxiliarypersonnelAvailabilityofaccuratemonitoring,inhalationandphysicaltherapyontheunitInteractionofthephysicians,nursesandtechniciansfromtheunitwithothermembersofhospitalstaffhasraisedthelevelofrespiratorycarefortheentireinstitutionImpactoftheRespiratoryIntensiveCareUnitonSurvivalofPatientswithAcuteRespiratoryFailureChest1972；62：94-97ConclusionImpa63ModesofMechanicalVentilationandWeaning-ANationalSurveyofSpanishHospital

1992.1Esdeban对西班牙47个ICU机械通气模式和脱机方法进行了调查，290名病人机械通气时间大于24小时

Chest1994;106:1188-1193ModesofMechanicalVentilatio64ModesofMechanicalVentilationandWeaning-ANationalSurveyofSpanishHospitalChest1994;106:1188-1193呼吸机可提供的模式病人应用的模式ModesofMechanicalVentilatio65ModesofMechanicalVentilationandWeaning-ANationalSurveyofSpanishHospital病人机械通气的天数Chest1994;106:1188-1193ModesofMechanicalVentilatio66ModesofMechanicalVentilationandWeaning-ANationalSurveyofSpanishHospital脱机模式与成功率T-piece最好SIMVPSSIMV+PSChest1994;106:1188-1193ModesofMechanicalVentilatio67HowistheMechanicalVentilationEmployedinICU？1996.11-1997.1Esteban主持8个国家412个ICU参加的机械通气流行病学调查共有4153住ICU病人，其中1638名机械通气（39%）AmJRespirCritCareMed2000;106:1450-1458HowistheMechanicalVentilat68HowistheMechanicalVentilationEmployedinICU？人工气道的选择（8个国家）AmJRespirCritCareMed2000;106:1450-1458HowistheMechanicalVentilat69HowistheMechanicalVentilationEmployedinICU？机械通气选择的模式脱机选择的模式

AmJRespirCritCareMed2000;106:1450-1458HowistheMechanicalVentilat70HowistheMechanicalVentilationEmployedinICU？A/C和PSV时呼吸机参数的设定AmJRespirCritCareMed2000;106:1450-1458HowistheMechanicalVentilat71HowistheMechanicalVentilationEmployedinICU？PEEP的设定AmJRespirCritCareMed2000;106:1450-1458HowistheMechanicalVentilat72HowistheMechanicalVentilationEmployedinICU？Insummary:机械通气模式多种多样，90%机械通气病人使用A/CorPSorPS+SIMVVt的选择通常是7-10ml/kgPEEP的选择多为5cmH2OSIMV和某些新的通气模式很少使用（允许性高碳酸症通气，无创通气）脱机的方式多种多样，使用SBT的不多AmJRespirCritCareMed2000;106:1450-1458HowistheMechanicalVentilat73MechanicalVentilationinOntaroio;1992-2000回顾性，队列调查研究1992-2000Ontario州住院病人资料库150755名非心脏手术病人，接受机械通气

CritCareMed2004；32：1504-1509MechanicalVentilationinOnta74MechanicalVentilationinOntaroio;1992-2000

92939495969798992000Change%MVPatient

15989161081696417303176861801718785196091938820MVper10,0000population20019920720821021121722321712InpatientBedday839479757452713867136239620961586199-26MVdaysPer10,0000Population868278170190392964349551810172410739411157310903026Mortality30day272829303131333332p<0.001MechanicalVentilationinOnta75CharacteristicsandOutcomesinAdultPatientsReceivingMechanicalVentilation-A

28-DayinternationalStudy多中心、前瞻性的队列研究20个国家，361个ICU，98.3.1-98.3.31共15757病人收入ICU，5183病人机械通气>12小时，观察28天平均机械通气时间5.9天平均ICU住院11.2天

JAMA，2002；287：345-355CharacteristicsandOutcomesi76CharacteristicsandOutcomesinAdultPatientsReceivingMechanicalVentilation-A

28-DayinternationalStudyCOPD&ARDS机械通气的模式（1.3.7天）COPDARDS

day1day3day7day1day3day7

(n=522)(n=283)(n=85)(n=231)(n=174)(n=82)MVModesNo(%)A/C344(65.9)180(63.6)57(67.1)165(67)111(63.8)50(61)SIMV/PS50(9.6)32(11.3)9(10.6)24(10.4)20(11.5)8(9.8)PS40(7.6)24(8.5)10(11.8)3(1.4)6(3.4)3(3.7)PCV20(3.9)11(3.9)2(2.4)24(10.4)23(13.2)13(15.9)SIMV24(4.6)10(3.5)2(2.4)10(4.2)4(2.3)2(2.4)JAMA，2002；287：345-355CharacteristicsandOutcomesi77CharacteristicsandOutcomesinAdultPatientsReceivingMechanicalVentilation-A

28-DayinternationalStudyCOPDARDSJAMA，2002；287：345-355CharacteristicsandOutcomesi78CharacteristicsandOutcomesinAdultPatientsReceivingMechanicalVentilation-A

28-DayinternationalStudy

JAMA，2002；287：345-355机械通气时间与存活率的关系CharacteristicsandOutcomesi79CharacteristicsandOutcomesinAdultPatientsReceivingMechanicalVentilation-A

28-DayinternationalStudy每日机械通气模式的变化JAMA，2002；287：345-355CharacteristicsandOutcomesi80TheChangingEpidemiologyofMechanicalVentilation:APopulation-basedStudy

JournalofIntensiveCareMed200621(3):173-1821996-2002回顾性调查研究，北卡罗来那州出院病人资料库，ICD-9修订版的诊断标准1996年机械通气病人285/10万，2002增加为314/10万，增加11%（p<0.05)TheChangingEpidemiologyofM81TheChangingEpidemiologyofMechanicalVentilation:APopulation-basedStudy

JournalofIntensiveCareMed200621(3):173-182机械通气病人合并肾脏病明显增加（96年17%vs02年24%）肾病TheChangingEpidemiologyofM82TheChangingEpidemiologyofMechanicalVentilation:APopulation-basedStudy

JournalofIntensiveCareMed200621(3):173-182机械通气病人医疗消费指数（CPI）增长12%TheChangingEpidemiologyofM83TheChangingEpidemiologyofMechanicalVentilation:APopulation-basedStudy

JournalofIntensiveCareMed200621(3):173-182出院病人回家45.5%下降到34.4%,回到NursingHome从7.3%增加到10.7%，回家的人越来越少TheChangingEpidemiologyofM84EvolutionofMechanicalVentilationinResponsetoClinicalResearch

多中心、前瞻性、队列研究23个国家，349个ICU4968名机械通气的病人入选对107个ICU中1675名病人与1998年1383名病人临床资料进行比较2004与1998临床使用机械通的变化

AmJRespirCritCareMed2008;177:170-177EvolutionofMechanicalVentil85EvolutionofMechanicalVentilationinResponsetoClinicalResearch

2004vs1998推测发生的变化？Noninvasivepositive-pressureventilation

IncreaseduseofNPPVforCOPDIncreaseduseofNPPVforAcutehypoxemicrespiratoryfailureARDSDecreasedtidalvolumesMinimalincreaseinlevelsofPEEPNochangeintheuseofpressure-controlmodesNochangeintheuseofpronepositionWeaningfrommechanicalventilationIncreaseduseofPSversusT-pieceinspontaneousbreathingtrialsIncreaseduseofspontaneousbreathingtrialstoassessextubationreadinessDecreaseduseofSIMVasamethodforgraduallyreducingventilationsupportIncreaseduseofPSasamethodforgraduallyreducingventilationsupportNosignificantchangeintracheostomyuuseortimingEvolutionofMechanicalVentil86EvolutionofMechanicalVentilationinResponsetoClinicalResearch

NPPV病人2004与1998的比较AmJRespirCritCareMed2008;177:170-177EvolutionofMechanicalVentil87NPPVNPPV的临床应用2004明显增加，包括COPD和ARFNPPV的时间增加（2vs3d,p=0.03)气管插管率和无明显变化。但NPPV成功的病人病死率有下降（20%vs10%，p=0.08)EvolutionofMechanicalVentilationinResponsetoClinicalResearch

AmJ