バイレベル・非侵襲的換気療法研究論文 | レスメド
バイレベル・非侵襲的換気療法
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COPDの患者さんへの非侵襲的換気療法

非侵襲的換気 (NIV) 療法または 非侵襲的陽圧換気 (NPPV) 療法は、小児の患者さんにも対応できる3、換気不全の効果的な治療法です。1-2

慢性閉塞性肺疾患 (COPD) の急性憎悪を来した患者さんでは、NPPV療法の実施により以下が期待できます。4-9

  • 気管内挿管の必要性の顕著な低減
  • 合併症発症率の低下
  • 院内感染の低減
  • 入院の短期化
  • 入院時死亡率の大幅な低下

COPDの患者さんへの長期治療効果は限定されているものの、在宅NPPV療法は高炭酸ガス症のある方には効果的である場合があります。10-12

NPPV療法は重度の神経筋疾患や胸壁障害の患者さんの疾患管理に重要な役割を果たします。 通常NPPV療法は、動脈血中の二酸化炭素分圧上昇による夜間低換気症や右心不全に起因する症状が見られる際に実施されます。13-14 NPPV療法はこうした患者さんにとっては非常に対効果費用の高い治療法です。15-16

参考資料

  1. Hess DR.  The evidence for noninvasive positive-pressure ventilation in the care of patients in acute respiratory failure: a systematic review of the literature.  Respir Care 2004;49(7):810-29.
  2. BTS Standards of Care Committee.  Non-invasive ventilation in acute respiratory failure  Thorax 2002;57(3):192-211.
  3. Chin K, Uemoto S, Takahashi K, Egawa H, Kasahara M, Fujimoto Y, Sumi K, Mishima M, Sullivan CE, Tanaka K.  Noninvasive ventilation for Paediatric patients including those under 1-year-old undergoing liver transplantation.  Liver Transpl 2005;11(2):188-95.
  4. Ram F, Picot J, Lightowler J, Wedzicha J.  Non-invasive positive pressure ventilation for treatment of respiratory failure due to exacerbations of chronic obstructive pulmonary disease.  Cochrane Database Syst Rev 2004;1:CD004104. Non-invasive positive pressure ventilation for treatment of respiratory failure due to exacerbations of chronic obstructive pulmonary disease.  Cochrane Database Syst Rev 2004;1:CD004104.
  5. Girou E, Brun-Buisson C, Taille S, Lemaire F, Brochard L.  Secular trends in nosocomial infections and mortality associated with noninvasive ventilation in patients with exacerbation of COPD and pulmonary edema.  JAMA 2003;290:2985-91.
  6. Conti G, Antonelli M, Navalesi P, Rocco M, Bufi M, Spadetta G, Meduri GU. Noninvasive vs. conventional mechanical ventilation in patients with chronic obstructive pulmonary disease after failure of medical treatment in the ward: a randomized trial.  Intensive Care Med 2002;28(12):1701-7.
  7. Plant PK, Owen JL, Elliott MW.Early use of non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease on general respiratory wards: a multicentre randomised controlled trial.  Lancet 2000;355:1931-5.
  8. Sinuff T, Keenan SP. Clinical practice guideline for the use of noninvasive positive pressure ventilation in COPD patients with acute respiratory failure.  J Crit Care 2004;19(2):82-91.
  9. Hill NS.  Noninvasive ventilation for chronic obstructive pulmonary disease.  Respir Care 2004;49(1):72-87; discussion 87-9.
  10. Wijkstra PJ, Lacasse Y, Guyatt GH, Goldstein RS.Nocturnal non-invasive positive pressure ventilation for stable chronic obstructive pulmonary disease.  Cochrane Database Syst Rev 2002;(3):CD002878.
  11. Jones SE, Packham S, Hebden M, Smith AP. Domiciliary Nocturnal Intermittent Positive Pressure Ventilation in Patients with Respiratory Failure Due to Severe COPD: Long Term Follow-up and Effect on Survival.  Thorax 1998;53:495-498.
  12. Meechan-Jones.  Nasal Pressure Support Ventilation Plus Oxygen Compared with Oxygen Therapy Alone in Hypercapnic COPD.  Am J Respir Crit Care Med 1995;152:538-44.
  13. Perrin C, Unterborn JN, Ambrosio CD, Hill NS. Pulmonary complications of chronic neuromuscular diseases and their management.  Muscle Nerve 2004;29(1):5-27.
  14. Shneerson JM, Simonds AK.  Noninvasive ventilation for chest wall and neuromuscular disorders.  Eur Respir J 2002;20:480-7.
  15. Plant PK, Owen JL, Parrott S, Elliott MW.  Cost effectiveness of ward based non-invasive ventilation for acute exacerbations of chronic obstructive pulmonary disease: economic analysis of randomised controlled trial.  BMJ 2003;326:956.
  16. Keenan SP, Gregor J, Sibbald WJ, Cook D, Gafni A.  Noninvasive positive pressure ventilation in the setting of severe, acute exacerbations of chronic obstructive pulmonary disease: more effective and less expensive.  Crit Care Med 2000;28:2094-102.