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НЕИНВАЗИВНАЯ ВЕНТИЛЯЦИЯ С ПОЛОЖИТЕЛЬНЫМ ДАВЛЕНИЕМ ПРИ ОСТРОЙ ХРОНИЧЕСКОЙ ДЫХАТЕЛЬНОЙ НЕДОСТАТОЧНОСТИ У БОЛЬНЫХ С ХРОНИЧЕСКОЙ ОБСТРУКТИВНОЙ БОЛЕЗНЬЮ ЛЕГКИХ

NONINVASIVE POSITIVE PRESSURE VENTILATION IN ACUTE ON CHRONIC RESPIRATORY FAILURE IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE

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Рубрика — Пульмонология
Rubric — Pulmonology
Тип статьи — Научная статья
Type — Memoir
Диапазон страниц в журнале №1 (8) за 2014 год66-76
№1 (8) 2014 pages — 66-76

Авторы

Authors

Аннотация

Summary

неинвазивная вентиляция с положительным давлением (НВПД) рекомендуется при острой хронической дыхательной недостаточности (ОХДН) у больных ХОБЛ в целях недопущения развития эндотрахеальной интубации и усовершенствования конечного результата. Целью исследования стало сравнение результатов медикаментозной терапии острой хронической дыхательной недостаточности у больных ХОБЛ с результатами подобной терапии, но уже с применением неинвазивной вентиляции с положительным давлением.

Chronic obstructive pulmonary disease (COPD) is characterized by progressive airflow obstruction and the destruction of lung parenchyma which in the turn leads to reduced alveolar ventilation; nocturnal and daytime gas exchange abnormalities, dyspnea, increased work of breathing and sleep disordered breathing. The eventual development of chronic respiratory failure is characterized by varying degrees of ventilation perfusion mismatch, hypoxia and hypercapnia [1]. Once hypercapnia develops, the 2 year mortality is approximately 30-40% [2].  Respiratory failure occurs when the respiratory system cannot oxygenate the blood and/or remove carbon dioxide from the blood. It can be either acute or chronic and is classified as either hypoxemic (type I) or hypercapnic (type II) respiratory failure. Acute hypercapnic respiratory failure frequently occurs in COPD patients experiencing acute exacerbations of COPD, due to a decrease in the drive to breathe [3].

Patients with severe COPD, especially those who have chronic respiratory failure, are vulnerable to a wide range of insults that lead to acute respiratory distress (acute on chronic respiratory failure) that requires hospital admission and often mechanical ventilation (4). Medical treatment of this common condition includes oxygen supplementation, drugs, removal of secretions and, when necessary, mechanical ventilation. Even if medical treatment is rapidly undertaken, patients often require prolonged hospitalization with poor prognosis when mechanical ventilation is not provided [4]. Noninvasive  positive pressure mechanical ventilation (NIMV) with medical therapy improves the outcome of patients with acute respiratory failure due to hypercapnic  decompensation of COPD.  NIMV improves oxygenation, decreases work of breathing, improves V/Q matching, decreases fatigue and increases minute ventilation [5,6].. Some of these physiological benefits may be sustained, thereby conferring possible long-term benefits. Compared to endotracheal (ET) intubation, there are also the added advantages of simplicity, patient comfort, maintenance of the ability of the patient to talk and swallow, and ease of implementation and discontinuation. Further, the need for ET intubation and its attendant complications, may be avoided [7].

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Authors

Музафер Сарьидин — Университет Ондакуш Майиз, Стамбул, Турция.
Muzaffer Sariaydin — Namik Kemal University, Istambul,Turkey .
Нейат Альтинташ — Университет Намик Кемаль, Стамбул, Турция.
Nejat Altintas — Namik Kemal University, Istambul,Turkey.
Озгур Инче — Университет Ондакуш Майиз, Стамбул, Турция.
Ozgur Ince — Ondokuz Mayis University, Istambul, Turkey.
Эсра Карабибер — Университет Ондакуш Майиз, Стамбул, Турция.
Esra Karabiber — Ondokuz Mayis University, Istambul, Turkey.