Review: adding non-invasive positive pressure ventilation to usual care reduces treatment failure in respiratory failure

摘要

The review by Ram ef al confirms generally accepted medical practice for management of respiratory failure precipitated by an acute exacerbation of COPD by summarily evaluating 14 RCTs. The effectiveness of externally assisted ventilation in reducing minute respiratory rate,increasing tidal volumes,and decreasing the work of breathing has been well documented.' These interventions markedly reduce PaCO_2 concentrations and arterial pH and increase oxygen uptake from the alveoli. Achieving these outcomes without resorting to invasive ventilation circumvents the complications associated with invasive ventilation.The authors identified study differences in patient selection,pressure settings, types of masks, and episodic duration of NPPV. For practitioners,the next step should be the establishment of a best practice algorithm to facilitate guided clinical decisions.Such an algorithm would need to address pressure settings (dependent on patient body mass index),appropriate types of mask, mask fitting, and accurate oxygen titration. It would also need to establish patient eligibility criteria, the most effective duration of ventilator episodes over the first 72 hours, monitoring of arterial blood gases, and the most cost effective and safe nursing environment for care.Providing nursing care to some patients with acute exacerbation of COPD with non-invasive ventilation on wards appears to be cost effective and safe when nursing staff are adequately trained and supported.