Riassunto
La ventilazione meccanica artificiale è un sistema di sostegno della funzionalità respiratoria che, mediante apposite apparecchiature (ventilatori), vicaria la respirazione autonoma in soggetti in cui risulti alterata, compromessa o artificialmente inibita (anestesia). La ventilazione non invasiva (NIV) include le differenti modalità ventilatorie che provvedono alla somministrazione di un supporto polmonare tramite le vie aeree superiori senza l’utilizzo di dispositivi inseriti nelle vie aeree quali tubi tracheali, maschere laringee o il ricorso a tracheotomie [1]. I ventilatori a pressione negativa sono stati gli unici presidi di assistenza ventilatoria non invasiva per molti anni. Nel 1928, Drinker progettò il primo polmone d’acciaio e nel 1931 Emerson ne sviluppò un modello più leggero e funzionale. In occasione di un’epidemia di polio in Danimarca, nel 1952, venne utilizzata la ventilazione a pressione positiva attraverso un tubo endotracheale con pochi effetti collaterali e, negli anni 80, fu riconosciuta l’efficacia della ventilazione a pressione positiva attraverso una maschera nasale per il trattamento della sleep apnea ostruttiva. Infine, fu negli anni 90 che la NIV guadagnò popolarità, con il miglioramento delle interfacce e l’obiettivo di ridurre le complicanze [2]. Fino a poco tempo fa, il supporto ventilatorio iniziava con l’intubazione, ma le moderne tecniche di ventilazione sono diventate più varie e complesse e la NIV non può più essere considerata un ponte, cioè uno strumento per rimandare o temporeggiare un eventuale intubazione tracheale con conseguente ventilazione meccanica invasiva, ma rappresenta oggi un valido trattamento per l’insufficienza respiratoria. Quest’ultima può essere semplificata in:
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Tipo 1: V/Q failure (alterazione del rapporto ventilazione-perfusione). Insufficienza respiratoria con ipossiemia e PaCO2 normale o bassa (ad esempio, ALI/ARDS, EPA, Polmonite, Embolia polmonare, Pneumotorace, Asma).
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Tipo 2: “Pump” failure (deficit di ventilazione). Insufficienza respiratoria con ipercapnia e ipossiemia (ad esempio, malattia del SNC e periferico come la poliomielite, anestesia e oppioidi, trauma cranico e cervicale, malattie del muscolo, malattie della gabbia toracica come scoliosi e trauma, asma grave, COPD).
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Cefalù, S., Quattrocchi, P. (2010). Ventilazione non invasiva. In: Pintaudi, S., Rizzato, L. (eds) Il neuroleso grave. Springer, Milano. https://doi.org/10.1007/978-88-470-1460-2_8
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