For nearly 60 years, clinicians and investigators have explored the possibility that non-invasive ventilatory assistance might improve the function of patients with stable severe chronic obstructive pulmonary disease (COPD).1 Early studies used negative pressure ventilators with the idea that the rest of the respiratory muscles would make them stronger, but these were poorly tolerated.2 For the past 30 years, studies using non-invasive positive pressure ventilation (NIV) have been performed to see if gas exchange and sleep quantity and quality would improve but results have been conflicting. As recently as 2013, a Cochrane analysis concluded that NIV for stable severe hypercapnic COPD ‘had no clinically or statistically significant effect on gas exchange, exercise tolerance, quality of life, lung function, respiratory muscle strength or sleep efficiency’ and should only be used in the context of a clinical trial’.3 Over the past 5 years, though, several important studies have been published that have altered thinking about the role of NIV for stable severe COPD. Kohnlein et al 4 randomised almost 200 severe stable patients (PaCO2 >6.67 kPa) to receive ‘high-intensity’ NIV (inspiratory pressure to lower PaCO2 by at least 20% and backup rate 2 breaths/min below spontaneous), or standard home oxygen. Twelve-month mortality (12% vs 33%) and St George’s Respiratory Questionnaire score were significantly better in the NIV group. More recently, Murphy et al 5 using ‘high-pressure NIV’ (with a lower set respiratory rate to allow spontaneous triggering) showed significant prolongation of the time to rehospitalisation or death in the NIV group compared with the standard oxygen group (4.3 vs 1.4 months) in patients with hypercapnic COPD recovering from acute exacerbations. However, another randomised controlled trial examining the role of …

中文翻译：

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无处可去：为稳定的重度 COPD 启动无创通气

近 60 年来，临床医生和研究人员一直在探索无创通气辅助可能改善稳定的严重慢性阻塞性肺疾病 (COPD) 患者功能的可能性。 1 早期研究使用负压呼吸机的想法是呼吸肌会使它们更强壮，但耐受性差。2 在过去的 30 年中，已经进行了使用无创正压通气 (NIV) 的研究，以查看气体交换和睡眠数量和质量是否会改善，但结果一直是矛盾的。就在 2013 年，Cochrane 的一项分析得出结论，稳定的重度高碳酸血症 COPD 的 NIV“对气体交换、运动耐力、生活质量、肺功能、呼吸肌力或睡眠效率'，并且只能在临床试验的背景下使用'3。不过，在过去 5 年中，发表了几项重要研究，改变了对 NIV 对稳定严重 COPD 作用的看法。Kohnlein 等人 4 将近 200 名病情稳定的重症患者 (PaCO2 >6.67 kPa) 随机分配接受“高强度”NIV（吸气压力以将 PaCO2 降低至少 20%，备用频率低于自发性呼吸 2 次/分钟）或标准家庭氧气. NIV 组的 12 个月死亡率（12% 对 33%）和圣乔治呼吸问卷评分明显更好。最近，Murphy 等人 5 使用“高压 NIV”（设置较低的呼吸频率以允许自发触发）显示，与标准氧气组相比，NIV 组的再住院或死亡时间显着延长（4.3 个月 vs 1.4 个月）。从急性加重中恢复的高碳酸血症 COPD 患者。然而，另一项随机对照试验检查了……的作用。