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Role of non-invasive ventilation (NIV) in the perioperative period

机译：无创通气（NIV）在围手术期的作用

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摘要

Anaesthesia, postoperative pain and surgery (more so if the site of the surgery approaches the diaphragm) will induce respiratory modifications: hypoxaemia, pulmonary volume decrease and atelectasis associated to a restrictive syndrome and a diaphragm dysfunction. These modifications of the respiratory function occur early after surgery and may induce acute respiratory failure (ARF). Maintenance of adequate oxygenation in the postoperative period is of major importance, especially when pulmonary complications such as ARF occur. Non-invasive ventilation (NIV) refers to techniques allowing respiratory support without the need of endotracheal intubation. Two types of NIV are commonly used: noninvasive continuous positive airway pressure (CPAP) and noninvasive positive pressure ventilation (NPPV) which delivers two levels of positive pressure (pressure support ventilation + positive end-expiratory pressure). NIV may be an important tool to prevent (prophylactic treatment) or to treat ARF avoiding intubation (curative treatment). The aims of NIV are: (1) to partially compensate for the affected respiratory function by reducing the work of breathing, (2) to improve alveolar recruitment with better gas exchange (oxygenation and ventilation) and (3) to reduce left ventricular after load increasing cardiac output and improving haemodynamics.
机译：麻醉，术后疼痛和手术（如果手术部位靠近the肌，则更是如此）将引起呼吸系统改变：低氧血症，肺容量减少以及与限制性综合征和diaphragm肌功能障碍相关的肺不张。呼吸功能的这些改变发生在手术后的早期，并可能诱发急性呼吸衰竭（ARF）。术后要保持足够的氧气是至关重要的，特别是在发生肺部并发症如ARF时。无创通气（NIV）是指无需气管内插管即可提供呼吸支持的技术。 NIV通常使用两种类型：无创持续气道正压通气（CPAP）和无创正压通气（NPPV），可提供两种水平的正压（压力支持通气+呼气末正压）。 NIV可能是预防（预防治疗）或治疗ARF避免插管（治疗）的重要工具。 NIV的目标是：（1）通过减少呼吸作用部分补偿受影响的呼吸功能;（2）通过更好的气体交换（充氧和通气）来改善肺泡募集;（3）减轻负荷后的左心室增加心输出量并改善血液动力学。

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