medicina49巻13号

2012年12月発行

今月の主題 急性心不全への挑戦 急性心不全の治療 【非薬物療法の適応】

呼吸管理―非侵襲的陽圧呼吸療法

著者： 弓野大¹²

所属機関： ¹ゆみのハートクリニック ²東京女子医科大学病院循環器内科

ページ範囲：P.2116 - P.2120

ポイント

★急性心不全のfirst line therapyとしてNIPPVの適切な使用が症状改善，気管内挿管率の減少などにつながる．

★NIPPVは循環動態酸素化，呼吸仕事量の改善をもたらす．

参考文献

1）Masip J, et al:Noninvasive ventilation in acute cardiogenic pulmonary edema；Systematic review and meta-analysis. JAMA 294:3124-3130, 2005

2）Peter JV, et al:Effect of non-invasive positive pressure ventilation（NIPPV）on mortality in patients with acute cardiogenic pulmonary oedema；A meta-analysis. Lancet 367:1155-1163, 2006

3）Gray A, et al:Noninvasive ventilation in acute cardiogenic pulmonary edema. N Engl J Med 359:142-151, 2008

4）Dickstein K, et al:ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008；The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC（HFA）and endorsed by the European Society of Intensive Care Medicine（ESICM）. Eur Heart J 29:2388-2442, 2008

5）Naughton MT, et al:Effect of continuous positive airway pressure on intrathoracic and left ventricular transmural pressures in patients with congestive heart failure. Circulation 91:1725-1731, 1995

6）Bradley TD, et al:Cardiac output response to continuous positive airway pressure in congestive heart failure. Am Rev Respir Dis 145:377-382, 1992

Am Rev Respir Dis 145:377-382, 19927）Lenique F, et al:Ventilatory and hemodynamic effects of continuous positive airway pressure in left heart failure. Am J Respir Crit Care Med 155:500-505, 1997

8）Viver E, et al:Diaphragm ultrasonography to estimate the work of breathing during non-invasive ventilation. Intensive Care Med 38:796-803, 2012

9）Plaisance P, et al:A randomized study of out-of-hospital continuous positive airway pressure for acute cardiogenic pulmonary oedema；Physiological and clinical effects. Eur Heart 28:2895-2901, 2007

10）Confalonieri M, et al:Acute respiratory failure in patients with severe community-acquired pneumonia. A prospective randomized evaluation of noninvasive ventilation. Am J Respir Crit Care Med 160:1585-1591, 1999