Tài liệu lớp CME Hô hấp

Bạn đang xem bản rút gọn của tài liệu. Xem và tải ngay bản đầy đủ của tài liệu tại đây (1.27 MB, 21 trang )



Phát hiện được triệu chứng của đợt cấp



Tổng quan căn nguyên của đợt cấp



Phương pháp điều trị bằng thuốc



Thơng khí hỗ trợ

◦

Thơng khí nhân tạo khơng xâm nhập

</div>
<span class='text_page_counter'>(3)</span><div class='page_container' data-page=3>



Ho tăng



Thay đổi tính chất của đờm

◦

Màu sắc

◦

Số lượng

◦

Độ đặc quánh



Khó thở tăng

Thay đổi

các triệu

chứng so

với triệu

chứng nền

hằng ngày

Điều trị

ngoại trú

</div>
<span class='text_page_counter'>(4)</span><div class='page_container' data-page=4>



Chẩn đoán phân biệt

◦

Phù phổi

◦

Tắc mạch phổi

◦

Viêm phổi

Khơng phải tất

cả các trường

hợp khó thở

và/hoặc thở rít

</div>
<span class='text_page_counter'>(5)</span><div class='page_container' data-page=5>

• Steroids

• Tiêm TM

• Methylprednisolone

• <b>Uống</b>

• <b>Tương đương sinh học</b>

• Prednisone 40 mg

• Kháng sinh

• Methylxanthines

• <b>Khơng khuyến cáo sử</b>

<b>dụng giai đoạn cấp</b>

• Oxy

• TRÁNH tăng oxy máu

• <b>Cường beta giao cảm</b>

• Kháng cholinergic

• Corticosteroids phun hít

• <b>Ít dữ liệu</b>

• <b>? Vai trị của bệnh nhân</b>

<b>ngoại trú</b>

</div>
<span class='text_page_counter'>(6)</span><div class='page_container' data-page=6>



Khơng xâm nhập

• Mask mũi- miệng

• Mask mũi

• Ống mũi (Pillows)



Xâm nhập

• Qua ống nội khí quản

• [Mở khí quản]

• Bán cấp hoặc cai máy kéo dài

Sử dụng

cho

bệnh

nhân

ngoại

</div>
<span class='text_page_counter'>(7)</span><div class='page_container' data-page=7>



Thơng khí nhân tạo khơng xâm nhập áp lực dương

• Suy hơ hấp tăng CO2 mất bù

• pH < 7.3

• PaCO2 > 45mmHg

Tỷ lệ tử vong

•11% vs 21%

Tỷ lệ đặt NKQ

•16% vs 33%

Tỷ lệ điều trị thất bại

•20% vs 42%

</div>
<span class='text_page_counter'>(8)</span><div class='page_container' data-page=8>



Thơng khí xâm nhập áp lực dương (IPPV)

• KHI NÀO ?

• Mức độ suy hơ hấp

• Căn ngun gây đợt cấp

• Thở BiPAP thất bại

• Tăng CO2 tiến triển gây biểu hiện thần kinh

• Toan hơ hấp nặng

• Khó thở khơng giảm

• Huyết động khơng ổn định

</div>
<span class='text_page_counter'>(9)</span><div class='page_container' data-page=9>



Thơng khí xâm nhập áp lực dương (IPPV)

• Quản lý

1. <b>Lựa chọn bệnh nhân</b>

• Triggering Modes

• Hỗ trợ Kiểm sốt (AC)

• Thơng khí ng

ắt quãng theo yêu cầu /Hỗ trợ áp lực (IMV/PS)

• [

Thơng khí hỗ trợ áp lực

]

(PSV) – Khơng sử dụng giai đoạn cấp

• Điều chỉnh FiO2 để đạt PaO2 = 60mmH (SpO2 = 88-92%)

• An thần tối thiểu–

Richland Aggitation Scale Score (RASS): zero - neg one

• Phục hồi chức năng hô hấp

2. Cơ học phổi và Thơng khí khơng đồng bộ

3. Rút nội khí quản sớm

Thường

cài đặt

mode

SIMV

</div>
<span class='text_page_counter'>(10)</span><div class='page_container' data-page=10>



Thơng khí nhân tạo xâm nhập (IPPV) –

Đối tượng

• Hỗ trợ- Kiểm sốt (AC) –

Lựa chọn đầu tiên

• BS lâm sàng kiểm sốt thơng khí phút tối thiểu

• BS cài đặt Vt (

5-7ml/Kg IBW

)

• BS cài đ

ặt tần số thở (

4 BPM th

<i>ấ</i>

p hơn t

<i>ầ</i>

n s

<i>ố</i>

th

<i>ở</i>

c

<i>ủ</i>

a BN

)

• T

ần số thở của BN trên tần số thở cài đặt của BS-Cài đặt Vt

• Thơng khí ngắt qng theo u cầu với Hỗ trợ áp lực

• BS lâm sàng kiểm sốt thơng khí phút tối thiểu

• BS cài đặt Vt, tần số thở

• T

ần số thở của BN trên tần số thở cài đặt của BS- Cài đặt Vt dựa vào tốc

độ dịng

• Thơng khí hỗ trợ áp lực –

KHƠNG khuyến cáo giai đoạn cấp

• Kiểm sốt thơng khí phút của bệnh nhân

• Xem xét t

ần số thở của bệnh nhân và Vt

• BS: Cài đặt áp lực hỗ trợ để giữ tần số thở < 30 BPM

• Associated with Poorer Sleep Architecture than AC

Cấp

Bán cấp

</div>
<span class='text_page_counter'>(11)</span><div class='page_container' data-page=11>



Thơng khí nhân tạo áp lực dương xâm nhập (IPPV) –

Khơng đồng thì

•

Nguyên nhân

A. Auto-PEEP (PEEP nội sinh)

B. Trigger Sensitivity

• Tốc độ dịng (1L/Second)

• Áp lực (-2cmH2O)

C. Lưu lượng thở (How Quickly the Breath Is Delivered)

</div>
<span class='text_page_counter'>(12)</span><div class='page_container' data-page=12>



Thơng khí nhân tạo áp lực dương xâm nhập (IPPV) –

Không đồng thì

•

Khắc phục sự cố

• COPD

Bệnh lý tắc nghẽn

Khí khơng thốt ra được

A. Auto-PEEP (PEEP nội sinh)

• Thêm áp lực cuối thì thở ra

• Tiến hành giữ áp lực cuối thì thở ra

• Auto-PEEP = Giữ áp lực cuối thì thở ra – Cài đặt PEEP

• Áp dụng PEEP

 Khắc phục được tăng công hô hấp gây ra bởi

Auto-PEEP

• Thêm PEEP vào để cài đặt PEEP

• Auto-PEEP (0.80) + Cài đặt PEEP

End-Exp Hold

12 cmH2O

Set PEEP

5 cmH2O

Auto-PEEP

7 cmH2O

0.80 Applied PEEP

6 cmH2O

MỨc giá trị gợi
ý ban đầu

Ví dụ



</div>
<span class='text_page_counter'>(13)</span><div class='page_container' data-page=13>



Thơng khí nhân tạo áp lực dương xâm nhập (IPPV) –

Khơng đồng thì

•

Khắc phục sự cố

B. Trigger Sensitivity

• Tốc độ dịng (2L/min)

• Thể tích mỗi đơn vị thời gian (L/phút) bệnh nhân tạo ra để "nói"

rằng máy thở chu kỳ thở như mong muốn.

• Áp lực (-2cmH2O)

• Áp lực âm bệnh nhân tạo ra để “nói” rằng máy thở chu kỳ như

mong muốn.

Suggested
Starting
Value

</div>
<span class='text_page_counter'>(14)</span><div class='page_container' data-page=14>



Thơng khí nhân tạo áp lực dương xâm nhập (IPPV) –

Khơng đồng thì

•

Khắc phục sự cố

C. Lưu lượng thở

• Mặc định 60/phút thường khơng đủ

• Tăng tốc độ dịng

= Tăng thời gian hít vào

</div>
<span class='text_page_counter'>(15)</span><div class='page_container' data-page=15>



Thơng khí nhân tạo xâm nhập (IPPV) –

Rút nội khí quản

• Rút nội khí quản sớm

• Th

ử cho BN tự thở (SBT)

• Tiến hành khi nào?

• Căn ngun gây suy hơ hấp vẫn cịn

• Thơng khí hỗ trợ tối thiểu (

FIO2 = 0.4, PEEP = 5cmH2O

)

• Thơng khí qua:

• Ống chữ T,

• Tối thiểu áp lực hỗ trợ/PEEP (

5 cmH2O/5 cmH2O)

• Ống tự động bù trừ (ATC)

• 30phút  Chỉ số thở nhanh nơng < 104

• Với tinh thần tỉnh táo và ít bài tiết đờm

• Nếu tự thở thất bại Rút NKQ cho thở BiPAP

Giảm:

Tỷ lệ tử vong

Viêm phổi thở máy

Thời gian thở máy

Mở khí quản

CHỈ ĐỐI

VỚI

COPD!

</div>
<span class='text_page_counter'>(16)</span><div class='page_container' data-page=16>

 Rappaport SH, Shpiner R, Yoshihara G, et al. Randomized, prospective trial of pressure-limitedversus volume-controlled ventilation

in severe respiratory failure. Crit Care Med 1994; 22:22.10.

 Prella M, Feihl F, Domenighetti G. Effects of short-term pressure-controlled ventilation on gasexchange, airway pressures, and gas

distribution in patients with acute lung injury/ARDS: comparisonwith volume-controlled ventilation. Chest 2002; 122:1382.11.

 Chiumello D, Pelosi P, Calvi E, et al. Different modes of assisted ventilation in patients with acuterespiratory failure. Eur Respir J

2002; 20:925.

 Jeffrey AA, Warren PM, Flenley DC. Acute hypercapnic respiratory failure in patients with chronicobstructive lung disease: risk factors

and use of guidelines for management. Thorax 1992; 47:34.

 Seneff MG, Wagner DP, Wagner RP, et al. Hospital and 1-year survival of patients admitted tointensive care units with acute

exacerbation of chronic obstructive pulmonary disease. JAMA 1995;274:1852.

 Slutsky AS. Mechanical ventilation. American College of Chest Physicians' Consensus Conference. Chest 1993; 104:1833.
 Laghi, F, Tobin, MJ. Indications for mechanical ventilation. In: Principles and Practice of Mechanical Ventilation. Tobin, MJ (Ed),

McGraw Hill, New York, 2006.p.129.

 Tobin MJ, Perez W, Guenther SM, et al. The pattern of breathing during successful and unsuccessful trials of weaning from

mechanical ventilation. Am Rev Respir Dis 1986; 134:1111.

 Tobin MJ, Guenther SM, Perez W, et al. in acute respiratory failureribcage-abdominal motion during Adults Remove successful and

unsuccessful trials of weaning from mechanical ventilation. Am Rev Respir Dis 1987;135:1320.

 Tobin MJ, Perez W, Guenther SM, et al. Does rib cage-abdominal paradox signify respiratory muscle fatigue? J Appl Physiol (1985)

1987; 63:851.

 Marini JJ, Smith TC, Lamb VJ. External work output and force generation during synchronizedintermittent mechanical ventilation.

Effect of machine assistance on breathing effort. Am Rev RespirDis 1988; 138:1169.

 Ward ME, Corbeil C, Gibbons W, et al. Optimization of respiratory muscle relaxation duringmechanical ventilation. Anesthesiology

1988; 69:29.

 Imsand C, Feihl F, Perret C, Fitting JW. Regulation of inspiratory neuromuscular output during synchronized intermittent mechanical

ventilation. Anesthesiology 1994; 80:13.

 MacIntyre NR. Respiratory function during pressure support ventilation. Chest 1986; 89:677.12. Brochard, L, Lellouche, F. Pressure

support ventilation. In: Principles and Practice of Mechanical Ventilation, Tobin, MJ (Ed), McGraw Hill, New York, 2006.p.221.

 Jubran A, Van de Graaff WB, Tobin MJ. Variability of patient-ventilator interaction with pressure support ventilation in patients with

chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1995; 152:129.

 Parthasarathy S, Jubran A, Tobin MJ. Cycling of inspiratory and expiratory muscle groups with the ventilator in airflow limitation. Am

J Respir Crit Care Med 1998; 158:1471.

 Leung P, Jubran A, Tobin MJ. Comparison of assisted ventilator modes on triggering, patient effort, and dyspnea. Am J Respir Crit

</div>
<span class='text_page_counter'>(17)</span><div class='page_container' data-page=17>

 Tobin MJ, Jubran A, Laghi F. Patient-ventilator interaction. Am J Respir Crit Care Med 2001;163:1059.

 Maheshwari V, Paioli D, Rothaar R, Hill NS. Utilization of noninvasive ventilation in acute carehospitals: a regional survey. Chest 2006; 129:1226.
 Demoule A, Girou E, Richard JC, et al. Increased use of noninvasive ventilation in French intensivecare units. Intensive Care Med 2006; 32:1747.
 Celikel T, Sungur M, Ceyhan B, Karakurt S. Comparison of noninvasive positive pressure ventilationwith standard medical therapy in hypercapnic

acute respiratory failure. Chest 1998; 114:1636.

 Sweet DD, Naismith A, Keenan SP, et al. Missed opportunities for noninvasive positive pressureventilation: a utilization review. J Crit Care 2008;

23:111.

 Organized jointly by the American Thoracic Society, the European Respiratory Society, the EuropeanSociety of Intensive Care Medicine, and the SociÈtÈ

de RÈanimation de Langue FranÁaise, andapproved by ATS Board of Directors, December 2000. International Consensus Conferences inIntensive Care
Medicine: noninvasive positive pressure ventilation in acute Respiratory failure. Am JRespir Crit Care Med 2001; 163:283.

 DÌaz GG, Alcaraz AC, Talavera JC, et al. Noninvasive positive-pressure ventilation to treathypercapnic coma secondary to respiratory failure. Chest

2005; 127:952.

 Scala R, Naldi M, Archinucci I, et al. Noninvasive positive pressure ventilation in patients with acuteexacerbations of COPD and varying levels of

consciousness. Chest 2005; 128:1657.

 Squadrone E, Frigerio P, Fogliati C, et al. Noninvasive vs invasive ventilation in COPD patients withsevere acute respiratory failure deemed to require

ventilatory assistance. Intensive Care Med 2004;30:1303.

 Paus-Jenssen ES, Reid JK, Cockcroft DW, et al. The use of noninvasive ventilation in acuterespiratory failure at a tertiary care center. Chest 2004;

126:165.

 Nava S, Navalesi P, Conti G. Time of non-invasive ventilation. Intensive Care Med 2006; 32:361.

 Collaborative Research Group of Noninvasive Mechanical Ventilation for Chronic ObstructivePulmonary Disease. Early use of non-invasive positive
pressure ventilation for acute exacerbations of chronic obstructive pulmonary disease: a multicentre randomized controlled trial. Chin Med J
(Engl)2005; 118:2034.

 Liesching T, Kwok H, Hill NS. Acute applications of noninvasive positive pressure ventilation. Chest2003; 124:699.13. Kacmarek, RM. Characteristics
of pressure-targeted ventilators used for noninvasive positive pressureventilation. Respir Care 1997; 42:380.

 Ferguson GT, Gilmartin M. CO2 rebreathing during BiPAP ventilatory assistance. Am J Respir CritCare Med 1995; 151:1126.

 Navalesi P, Fanfulla F, Frigerio P, et al. Physiologic evaluation of noninvasive mechanical ventilation delivered with three types of masks in patients

with chronic hypercapnic respiratory failure. Crit CareMed 2000; 28:1785.

 Lemyze M, Mallat J, Nigeon O, et al. Rescue therapy by switching to total face mask after failure offace mask-delivered noninvasive ventilation in

do-not-intubate patients in acute respiratory failure. CritCare Med 2013; 41:481.

 Girault C, Briel A, Benichou J, et al. Interface strategy during noninvasive positive pressure ventilationfor hypercapnic acute respiratory failure. Crit

</div>
<span class='text_page_counter'>(18)</span><div class='page_container' data-page=18>

 Soo Hoo GW, Santiago S, Williams AJ. Nasal mechanical ventilation for hypercapnic respiratoryfailure in chronic obstructive

pulmonary disease: determinants of success and failure. Crit Care Med1994; 22:1253.

 Hess, D. Noninvasive positive pressure ventilation: Predictors of success and failure for adult acutecare applications. Respir Care

1997; 42:424.20. Turner, RE. NIPPV: Face versus Interface. Respir Care 1997; 42:389.

 Holland AE, Denehy L, Buchan CA, Wilson JW. Efficacy of a heated passover humidifier duringnoninvasive ventilation: a bench study.

Respir Care 2007; 52:38.

 Antonelli M, Conti G, Pelosi P, et al. New treatment of acute hypoxemic respiratory failure:noninvasive pressure support ventilation

delivered by helmet--a pilot controlled trial. Crit Care Med2002; 30:602.

 Gregoretti C, Confalonieri M, Navalesi P, et al. Evaluation of patient skin breakdown and comfort witha new face mask for

non-invasive ventilation: a multi-center study. Intensive Care Med 2002; 28:278.

 Antonelli M, Pennisi MA, Pelosi P, et al. Noninvasive positive pressure ventilation using a helmet inpatients with acute exacerbation

of chronic obstructive pulmonary disease: a feasibility study.Anesthesiology 2004; 100:16.

 Navalesi P, Costa R, Ceriana P, et al. Non-invasive ventilation in chronic obstructive pulmonary disease patients: helmet versus facial

mask. Intensive Care Med 2007; 33:74.

 Patroniti N, Foti G, Manfio A, et al. Head helmet versus face mask for non-invasive continuous positive airway pressure: a

physiological study. Intensive Care Med 2003; 29:1680.

 Cavaliere F, Conti G, Costa R, et al. Noise exposure during noninvasive ventilation with a helmet, a nasal mask, and a facial mask.

Intensive Care Med 2004; 30:1755.

 Racca F, Appendini L, Gregoretti C, et al. Helmet ventilation and carbon dioxide rebreathing: effects of adding a leak at the helmet

ports. Intensive Care Med 2008; 34:1461.

 Bott J, Carroll MP, Conway JH, et al. Randomised controlled trial of nasal ventilation in acuteventilatory failure due to chronic

obstructive airways disease. Lancet 1993; 341:1555.

 Brochard, L, Mancebo, J, Wysocki, M, et al. Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease.

</div>
<span class='text_page_counter'>(19)</span><div class='page_container' data-page=19>

 Ferrer M, Esquinas A, Leon M, et al. Noninvasive ventilation in severe hypoxemic respiratory failure: a randomized clinical trial. Am J

Respir Crit Care Med 2003; 168:1438.

 Wysocki M, Tric L, Wolff MA, et al. Noninvasive pressure support ventilation in patients with acute respiratory failure. A randomized

comparison with conventional therapy. Chest 1995; 107:761.

 Kramer N, Meyer TJ, Meharg J, et al. Randomized, prospective trial of noninvasive positive pressure ventilation in acute respiratory

failure. Am J Respir Crit Care Med 1995; 151:1799.

 Martin TJ, Hovis JD, Costantino JP, et al. A randomized, prospective evaluation of noninvasive ventilation for acute respiratory failure.

Am J Respir Crit Care Med 2000; 161:807.

 Gay PC, Hess DR, Hill NS. Noninvasive proportional assist ventilation for acute respiratoryinsufficiency. Comparison with pressure

support ventilation. Am J Respir Crit Care Med 2001;164:1606.

 Wysocki M, Richard JC, Meshaka P. Noninvasive proportional assist ventilation compared with noninvasive pressure support

ventilation in hypercapnic acute respiratory failure. Crit Care Med 2002;30:323.

 Fern·ndez-Vivas M, Caturla-Such J, Gonz·lez de la Rosa J, et al. Noninvasive pressure support versus proportional assist ventilation

in acute respiratory failure. Intensive Care Med 2003; 29:1126

 Girault C, Richard JC, Chevron V, et al. Comparative physiologic effects of noninvasive assist-control and pressure support

ventilation in acute hypercapnic respiratory failure. Chest 1997; 111:1639.

 Vitacca M, Rubini F, Foglio K, et al. Non-invasive modalities of positive pressure ventilation improve the outcome of acute

exacerbations in COLD patients. Intensive Care Med 1993; 19:450.

 AntÛn A, G¸ell R, GÛmez J, et al. Predicting the result of noninvasive ventilation in severe acute exacerbations of patients with

chronic airflow limitation. Chest 2000; 117:828.

 Appendini L, Patessio A, Zanaboni S, et al. Physiologic effects of positive end-expiratory pressure and mask pressure support during

exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1994; 149:1069.

 Peter JV, Moran JL, Phillips-Hughes J, et al. Effect of non-invasive positive pressure ventilation (NIPPV) on mortality in patients with

acute cardiogenic pulmonary oedema: a meta-analysis. Lancet 2006; 367:1155.

 Nouira S, Boukef R, Bouida W, et al. Non-invasive pressure support ventilation and CPAP incardiogenic pulmonary edema: a

multicenter randomized study in the emergency department.Intensive Care Med 2011; 37:249.

 Kacmarek RM. NIPPV: patient-ventilator synchrony, the difference between success and failure? Intensive Care Med 1999; 25:645.
 Vignaux L, Vargas F, Roeseler J, et al. Patient-ventilator asynchrony during non-invasive ventilation for acute respiratory failure: a

</div>
<span class='text_page_counter'>(20)</span><div class='page_container' data-page=20>

 Vitacca M. New things are not always Better: proportional assist ventilation vs. pressure support ventilation. Intensive Care Med 2003; 29:1038.
 Calderini E, Confalonieri M, Puccio PG, et al. Patient-ventilator asynchrony during noninvasive ventilation: the role of expiratory trigger. Intensive Care

Med 1999; 25:662.

 Poponick JM, Renston JP, Bennett RP, Emerman CL. Use of a ventilatory support system (BiPAP) for acute respiratory failure in the emergency

department. Chest 1999; 116:166.

 Karnik AM. Noninvasive positive pressure ventilation: testing the bridge. Chest 2000; 117:625.50. Antonelli M, Conti G, Moro ML, et al. Predictors of

failure of noninvasive positive pressure ventilationin patients with acute hypoxemic respiratory failure: a multi-center study. Intensive Care Med
2001;27:1718.

 Esteban A, Anzueto A, Frutos F, et al. Characteristics and outcomes in adult patients receiving mechanical ventilation: a 28-day international study.

JAMA 2002; 287:345. Page 12 of 1452.

 Wunderink, RG, Hill, NS. Continuous and periodic applications of noninvasive ventilation in respiratory failure. Respir Care 1997; 42:394.
 Demoule A, Girou E, Richard JC, et al. Benefits and risks of success or failure of noninvasiveventilation. Intensive Care Med 2006; 32:1756.

 GuÈrin C, Girard R, Chemorin C, et al. Facial mask noninvasive mechanical ventilation reduces the incidence of nosocomial pneumonia. A prospective

epidemiological survey from a single ICU.Intensive Care Med 1997; 23:1024.

 Hess DR. Noninvasive positive-pressure ventilation and ventilator-associated pneumonia. Respir Care 2005; 50:924.

 Antonelli M, Conti G, Rocco M, et al. A comparison of noninvasive positive-pressure ventilation and conventional mechanical ventilation in patients

with acute respiratory failure. N Engl J Med 1998;339:429.

 Girou E, Schortgen F, Delclaux C, et al. Association of noninvasive ventilation with nosocomial infections and survival in critically ill patients. JAMA

2000; 284:2361.

 Peter JV, Moran JL, Phillips-Hughes J, Warn D. Noninvasive ventilation in acute respiratory failure--a meta-analysis update. Crit Care Med 2002;
30:555.

 Mehta S, Hill NS. Noninvasive ventilation. Am J Respir Crit Care Med 2001; 163:540.60. Ram FS, Picot J, Lightowler J, Wedzicha JA. Non-invasive
positive pressure ventilation for treatment of respiratory failure due to exacerbations of chronic obstructive pulmonary disease. CochraneDatabase
Syst Rev 2004; :CD004104.

 Keenan SP, Sinuff T, Cook DJ, Hill NS. Which patients with acute exacerbation of chronic obstructive pulmonary disease benefit from noninvasive

positive-pressure ventilation? A systematic review of the literature. Ann Intern Med 2003; 138:861.

 Williams JW, Cox CE, Hargett CW, et al. Noninvasive Positive-Pressure Ventilation (NPPV) for Acute Respiratory Failure. Duke Evidence-based Practice

Center; Agency for Healthcare Research and Quality (US), Rockville, MD 2012.63. Keenan SP, Powers CE, McCormack DG. Noninvasive
positive-pressure ventilation in patients with milder chronic obstructive pulmonary disease exacerbations: a randomized controlled trial. Respir Care 2005;
50:610.

 Conti G, Antonelli M, Navalesi P, et al. Noninvasive vs. conventional mechanical ventilation in patients with chronic obstructive pulmonary disease

</div>
<span class='text_page_counter'>(21)</span><div class='page_container' data-page=21>

 Diaz O, Iglesia R, Ferrer M, et al. Effects of noninvasive ventilation on pulmonary gas exchange and hemodynamics during acute

hypercapnic exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1997; 156:1840.

 Masip J, Roque M, S·nchez B, et al. Noninvasive ventilation in acute cardiogenic pulmonary edema: systematic review and

meta-analysis. JAMA 2005; 294:3124.

 Winck JC, Azevedo LF, Costa-Pereira A, et al. Efficacy and safety of non-invasive ventilation in the treatment of acute cardiogenic

pulmonary edema--a systematic review and meta-analysis. Crit Care 2006; 10:R69.

 Collins SP, Mielniczuk LM, Whittingham HA, et al. The use of noninvasive ventilation in emergency department patients with acute

cardiogenic pulmonary edema: a systematic review. Ann Emerg Med 2006; 48:260.

 Gray A, Goodacre S, Newby DE, et al. Noninvasive ventilation in acute cardiogenic pulmonary edema. N Engl J Med 2008; 359:142.
 Weng CL, Zhao YT, Liu QH, et al. Meta-analysis: Noninvasive ventilation in acute cardiogenicpulmonary edema. Ann Intern Med

2010; 152:590.

 Masip J, BetbesÈ AJ, P·ez J, et al. Non-invasive pressure support ventilation versus conventional oxygen therapy in acute cardiogenic

pulmonary oedema: a randomised trial. Lancet 2000; 356:2126.

 Vital FM, Ladeira MT, Atallah AN. Non-invasive positive pressure ventilation (CPAP or bilevel NPPV) for cardiogenic pulmonary

oedema. Cochrane Database Syst Rev 2013; 5:CD005351.

 Banner MJ, Kirby RR, Blanch PB, Layon AJ. Decreasing imposed work of the breathing apparatus to zero using pressure-support

ventilation. Crit Care Med 1993; 21:1333.

 Brochard L, Rua F, Lorino H, et al. Inspiratory pressure support compensates for the additional workof breathing caused by the

endotracheal tube. Anesthesiology 1991; 75:739.ez

 P, Cabello B, et al. Patient-ventilator asynchrony during assisted mechanicalventilation. Intensive Care Med 2006; 32:1515.
 Toublanc B, Rose D, GlÈrant JC, et al. Assist-control ventilation vs. low levels of pressure support ventilation on sleep quality in

intubated ICU patients. Intensive Care Med 2007; 33:1148.

 Vitacca M, Bianchi L, Zanotti E, et al. Assessment of physiologic variables and subjective comfort under different levels of pressure

</div>