Title: Non-invasive Ventilation (NIV): What’s the Evidence?
题目：非创伤性（无创）通气（NIV）：有支持证据吗？
Author 作者: Haney Mallemat

Emergency Medicine physicians are gaining experience with non-invasive ventilation (i.e., Bi-level ventilation and continuous positive-pressure ventilation) in managing respiratory distress and failure. Although NIV is commonly used across a variety of pathologies, the best data exists for use with COPD exacerbation and cardiogenic pulmonary edema (CHF, not an acute MI) 
急诊医生在处理呼吸困难或衰竭中使用包括双期通气（BiPAP）和持续正压通气（CPAP）的经验越来越丰富。虽然非创伤性通气在很多的病理情况下应用，但最有力的证据还是在治疗COPD恶化和心源性肺水肿（CHF）的应用。
 
Although other indications for NIV have been studied, the data is less robust (eg., smaller study size, weak control groups, etc.). If there are no contraindications, however, many experts still support a trial of NIV in the following populations:
虽然NIV在其它方面的应用已有报道，但都由于样品小或对照组不强等原因而不充足。如没有禁忌症，很多专家还是建议在下列情况下可考虑使用NIV。
Asthma 哮喘
Severe community acquired pneumonia 危重型院外获得性肺炎
Acute lung injury / Acute Respiratory Distress Syndrome 急性肺损伤／急性呼吸窘迫综合征
Chest trauma (lung contusion, rib fractures, flail chest,etc) 胸部外伤（肺挫伤，肋骨骨折，连枷胸，等）
Immunosuppression with acute respiratory failure 急性呼吸衰竭造成的免疫抑制
Neuromuscular respiratory failure (eg., Myesthenia Gravis) 神经肌肉功能紊乱造成的呼吸衰竭（如重症肌无力）
Cystic Fibrosis 囊肿性纤维化
Pneumocystis Jiroveci Pneumonia 肺囊虫肺炎
“Do not intubate” status ‘放弃抢救’状态
 
Failure to clinically improve during a NIV trial should prompt invasive mechanical ventilation.
如NIV用一段时间没有改善，要及时改用机械通气。

References 参考文献：
Keenan, S. et al. Clinical practice guidelines for the use of noninvasive positive-pressure ventilation and noninvasive continuous positive airway pressure in the acute care setting. CMAJ. 2011 Feb 22;183(3):E195-214. Epub 2011 Feb 14.