Physiological effects of high-intensity versus low-intensity noninvasive positive pressure ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease: a randomised controlled trial,Annals of Intensive Care

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Physiological effects of high-intensity versus low-intensity noninvasive positive pressure ventilation in patients with acute exacerbation of chronic obstructive pulmonary disease: a randomised controlled trial
Annals of Intensive Care ( IF 5.7 ) Pub Date : 2022-05-19 , DOI: 10.1186/s13613-022-01018-4
Zujin Luo _{1,

2} , Zhixin Cao ₂ , Yichong Li ₃ , Jiawei Jin ₂ , Wei Sun ₂ , Jian Zhu ₂ , Na Zhao ₂ , Jichen Liu ₂ , Bing Wei ₄ , Yue Hu ₄ , Ying Zhang ₄ , Yingmin Ma ₅ , Chen Wang _{6,

7,

8,

9}

Affiliation

Xuanwu Hospital, Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing, 100053, China.
Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, No. 5 Jingyuan Road, Shijingshan District, Beijing, 100043, China.
Department of Clinical Research and Epidemiology, Fuwai Hospital Chinese Academy of Medical Sciences, No. 12 Lanshan Road, Nanshan District, Shenzhen, 518057, Guangdong Province, China.
Department of Emergency Medicine, Beijing Chao-Yang Hospital Western Branch, Capital Medical University, No. 5 Jingyuan Road, Shijingshan District, Beijing, 100043, China.
Department of Respiratory and Critical Care Medicine, Beijing Youan Hospital, Capital Medical University, No. 8, Xi Tou Tiao, Youanmen wai, Fengtai District, Beijing, 100069, China.
Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, No. 2 Yinghua East Street, Chaoyang District, Beijing, 100029, China.
National Clinical Research Center for Respiratory Diseases, Beijing, China.
Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Respiratory Medicine, Capital Medical University, Beijing, China.

Background

High-intensity noninvasive positive pressure ventilation (NPPV) is a novel ventilatory approach to maximally decreasing elevated arterial carbon dioxide tension (PaCO₂) toward normocapnia with stepwise up-titration of pressure support. We tested whether high-intensity NPPV is more effective than low-intensity NPPV at decreasing PaCO₂, reducing inspiratory effort, alleviating dyspnoea, improving consciousness, and improving NPPV tolerance in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).

Methods

In this physiological, randomised controlled trial, we assigned 24 AECOPD patients to undergo either high-intensity NPPV (n = 12) or low-intensity NPPV (n = 12). The primary outcome was PaCO₂ 24 h after randomisation. Secondary outcomes included gas exchange other than PaCO₂ 24 h after randomisation, inspiratory effort, dyspnoea, consciousness, NPPV tolerance, patient–ventilator asynchrony, cardiac function, ventilator-induced lung injury (VILI), and NPPV-related adverse events.

Results

Inspiratory positive airway pressure 24 h after randomisation was significantly higher (28.0 [26.0–28.0] vs. 15.5 [15.0–17.5] cmH₂O; p = 0.000) and NPPV duration within the first 24 h was significantly longer (21.8 ± 2.1 vs. 15.3 ± 4.7 h; p = 0.001) in the high-intensity NPPV group. PaCO₂ 24 h after randomisation decreased to 54.0 ± 11.6 mmHg in the high-intensity NPPV group but only decreased to 67.4 ± 10.6 mmHg in the low-intensity NPPV group (p = 0.008). Inspiratory oesophageal pressure swing, oesophageal pressure–time product (PTPes)/breath, PTPes/min, and PTPes/L were significantly lower in the high-intensity group. Accessory muscle use and dyspnoea score 24 h after randomisation were also significantly lower in that group. No significant between-groups differences were observed in consciousness, NPPV tolerance, patient–ventilator asynchrony, cardiac function, VILI, or NPPV-related adverse events.

Conclusions

High-intensity NPPV is more effective than low-intensity NPPV at decreasing elevated PaCO₂, reducing inspiratory effort, and alleviating dyspnoea in AECOPD patients.

Trial registration: ClinicalTrials.gov (NCT04044625; registered 5 August 2019).

中文翻译：

高强度与低强度无创正压通气对慢性阻塞性肺疾病急性加重患者的生理影响：一项随机对照试验

背景

高强度无创正压通气 (NPPV) 是一种新的通气方法，可通过逐步升高压力支持最大限度地降低升高的动脉二氧化碳张力 (PaCO _{2 ) 至正常碳酸血症。}我们测试了高强度 NPPV 是否比低强度 NPPV 在降低 PaCO ₂、减少吸气努力、缓解呼吸困难、改善意识和改善慢性阻塞性肺疾病急性加重 (AECOPD) 患者的 NPPV 耐受性方面更有效。

方法

在这项生理学、随机对照试验中，我们分配 24 名 AECOPD 患者接受高强度 NPPV ( n = 12) 或低强度 NPPV ( n = 12)。主要结果是随机分组后₂₄小时的 PaCO2。_{次要结局包括随机分组后24}小时内除 PaCO2 以外的气体交换、吸气努力、呼吸困难、意识、NPPV 耐受性、人机不同步、心功能、呼吸机引起的肺损伤 (VILI) 和 NPPV 相关的不良事件。

结果

随机分组后 24 小时的吸气气道正压显着升高（28.0 [26.0-28.0] vs. 15.5 [15.0-17.5] cmH ₂ O；p = 0.000），前 24 小时内的 NPPV 持续时间明显更长（21.8 ± 2.1 vs. . 15.3 ± 4.7 h；p = 0.001) 在高强度 NPPV 组中。PaCO ₂随机分组后 24 小时，高强度 NPPV 组降至 54.0 ± 11.6 mmHg，但低强度 NPPV 组仅降至 67.4 ± 10.6 mmHg (p = 0.008)。高强度组的吸气食管压力摆动、食管压力-时间乘积 (PTPes)/呼吸、PTPes/min 和 PTPes/L 显着降低。随机分组后 24 小时的辅助肌肉使用和呼吸困难评分在该组中也显着降低。在意识、NPPV 耐受性、人机同步性、心脏功能、VILI 或 NPPV 相关不良事件方面未观察到显着的组间差异。