Noninvasive continuous positive airway pressure in elderly cardiogenic pulmonary edema patients Treatment of acute hypoxemic nonhypercapnic respiratory insufficiency with continuous positive airway pressure delivered by a face mask: A randomized controlled trial. Benefits and risks of success or failure of noninvasive ventilation Noninvasive ventilation for treating acute respiratory failure in AIDS patients with Pneumocystis carinii pneumonia Noninvasive ventilation for treatment of acute respiratory failure in patients undergoing solid organ transplantation: a randomized trial. Noninvasive ventilation reduces mortality in acute respiratory failure following lung resection. Increased use of noninvasive ventilation in French intensive care units Noninvasive positive-pressure ventilation for respiratory failure after extubation. Noninvasive ventilation in acute cardiogenic pulmonary edema. Noninvasive positive pressure ventilation in acute respiratory failure due to COPD vs other causes: Effectiveness and predictors of failure in a respiratory ICU in North India A multiple‐center survey on the use in clinical practice of noninvasive ventilation as a first‐line intervention for acute respiratory distress syndrome* Continuous positive airway pressure for treatment of postoperative hypoxemia: a randomized controlled trial. Noninvasive pressure support ventilation in patients with acute respiratory failure. A randomized comparison with conventional therapy. Noninvasive ventilation in immunosuppressed patients with pulmonary infiltrates, fever, and acute respiratory failure. Noninvasive ventilation in severe hypoxemic respiratory failure: a randomized clinical trial. Noninvasive positive-pressure ventilation for postextubation respiratory distress: a randomized controlled trial.
Objective To compare the physiological effects and the clinical efficacy of continuous positive airway pressure ( CPAP ) vs st and ard medical treatment in elderly patients ( ≥75 years ) with acute hypoxemic respiratory failure related to cardiogenic pulmonary edema . Design A prospect i ve , r and omized , concealed , and unblinded study of 89 consecutive patients who were admitted to the emergency departments of one general , and three teaching , hospitals . Intervention Patients were r and omly assigned to receive st and ard medical treatment alone ( n=46 ) or st and ard medical treatment plus CPAP ( n=43 ) . Measurements Improvement in PaO2/FIO2 ratio , complications , length of hospital stay , early 48-h and overall mortality , compared between the CPAP and st and ard treatment groups . Results Study groups were comparable with regard to baseline physiological and clinical characteristics ( age , sex ratio , autonomy , medical history , cause of pulmonary edema ) . Within 1 h , noninvasive continuous positive airway pressure led to decreased respiratory rate ( respiratory rate , 27±7 vs 35±6 breaths/min ; p=0.009 ) , and improved oxygenation ( PaO2/FIO2 , 306±104 vs 157±71 ; p=0.004 ) compared with baseline , whereas no differences were observed within the st and ard treatment group . Severe complications occurred in 17 patients in the st and ard treatment group , vs 4 patients in the noninvasive continuous positive airway pressure group ( p=0.002 ) . Early 48-h mortality was 7 % in the noninvasive continuous positive airway pressure group , compared with 24 % in the st and ard treatment group ( p=0.017 ) ; however , no sustained benefits were observed during the overall hospital stay . Conclusion Noninvasive continuous positive airway pressure promotes early clinical improvement in elderly patients attending emergency departments for a severe pulmonary edema , but only reduces early 48-h mortality CONTEXT Continuous positive airway pressure ( CPAP ) is widely used in the belief that it may reduce the need for intubation and mechanical ventilation in patients with acute hypoxemic respiratory insufficiency . OBJECTIVE To compare the physiologic effects and the clinical efficacy of CPAP vs st and ard oxygen therapy in patients with acute hypoxemic , nonhypercapnic respiratory insufficiency . DESIGN , SETTING , AND PATIENTS R and omized , concealed , and unblinded trial of 123 consecutive adult patients who were admitted to 6 intensive care units between September 1997 and January 1999 with a PaO(2)/FIO(2 ) ratio of 300 mm Hg or less due to bilateral pulmonary edema ( n = 102 with acute lung injury and n = 21 with cardiac disease ) . INTERVENTIONS Patients were r and omly assigned to receive oxygen therapy alone ( n = 61 ) or oxygen therapy plus CPAP ( n = 62 ) . MAIN OUTCOME MEASURES Improvement in PaO(2)/FIO(2 ) ratio , rate of endotracheal intubation at any time during the study , adverse events , length of hospital stay , mortality , and duration of ventilatory assistance , compared between the CPAP and st and ard treatment groups . RESULTS Among the CPAP vs st and ard therapy groups , respectively , causes of respiratory failure ( pneumonia , 54 % and 55 % ) , presence of cardiac disease ( 33 % and 35 % ) , severity at admission , and hypoxemia ( median [ 5th-95th percentile ] PaO(2)/FIO(2 ) ratio , 140 [ 59 - 288 ] mm Hg vs 148 [ 62 - 283 ] mm Hg ; P = .43 ) were similarly distributed . After 1 hour of treatment , subjective responses to treatment ( P<.001 ) and median ( 5th-95th percentile ) PaO(2)/FIO(2 ) ratios were greater with CPAP ( 203 [ 45 - 431 ] mm Hg vs 151 [ 73 - 482 ] mm Hg ; P = .02 ) . No further difference in respiratory indices was observed between the groups . Treatment with CPAP failed to reduce the endotracheal intubation rate ( 21 [ 34 % ] vs 24 [ 39 % ] in the st and ard therapy group ; P = .53 ) , hospital mortality ( 19 [ 31 % ] vs 18 [ 30 % ] ; P = .89 ) , or median ( 5th-95th percentile ) intensive care unit length of stay ( 6.5 [ 1 - 57 ] days vs 6.0 [ 1 - 36 ] days ; P = .43 ) . A higher number of adverse events occurred with CPAP treatment ( 18 vs 6 ; P = .01 ) . CONCLUSION In this study , despite early physiologic improvement , CPAP neither reduced the need for intubation nor improved outcomes in patients with acute hypoxemic , nonhypercapnic respiratory insufficiency primarily due to acute lung injury . JAMA . 2000;284:2352 - 2360 Objective Noninvasive ventilation ( NIV ) fails more frequently for de novo acute respiratory failure ( de novo ) than for cardiogenic pulmonary edema ( CPE ) or acute-on-chronic respiratory failure ( AOC ) . The impact of NIV failure and success was compared between de novo and CPE or AOC after adjustment for disease severity . Setting s Patients requiring ventilatory support were enrolled in a prospect i ve survey in 70 French ICUs . Of 1076 patients requiring ventilatory support , 524 were eligible , including 299 de novo ( NIV use , 30 % ) and 225 CPE-AOC ( NIV use , 55 % ) . Design and analysis Independent risk factors associated with mortality and length of stay were identified by logistic regression analysis . The adjusted outcome of NIV success or failure was compared to that with endotracheal intubation without NIV . Results  NIV success was independently associated with survival in both de novo , adjusted OR 0.05 ( 95 % CI 0.01–0.42 ) , and CPE-AOC OR 0.03 ( CI 0.01–0.24 ) . NIV failure was associated with ICU mortality in the de novo group ( OR 3.24 , CI 1.61–6.53 ) but not in the CPE-AOC group . Nosocomial pneumonia was less common in patients successful with NIV .  NIV failure was associated with a longer ICU stay in CPE-AOC only . The overall use of NIV was independently associated with a better outcome only in CPE-AOC patients ( OR 0.33 , CI 0.15–0.73 ) . Conclusion The effect of NIV differs between de novo and CPE-AOC patients because NIV failure is associated with increased mortality for de novo patients . This finding should raise a note of caution when applying NIV in this indication Objective . To compare noninvasive positive pressure ventilation ( NPPV ) vs. invasive mechanical ventilation in AIDS patients with Pneumocystis carinii pneumonia (PCP)-related acute respiratory failure ( ARF ) . Design : A single-center , prospect i ve , case-control trial . Setting : An ICU of a private tertiary hospital specialized in infectious disease . Patients : Forty-eight AIDS patients with severe PCP-related ARF needing mechanical ventilation . Interventions : Twenty-four patients treated with NPPV by a facial mask strictly matched with 24 patients treated with invasive ventilation by endotracheal intubation . Results : Use of NPPV  avoided intubation in 67 % of patients , and avoidance of intubation was associated with improved survival ( 100 % vs. 38 % ; P=0.003 ) . NPPV-treated patients required fewer invasive devices ( P<0.001 ) and had a lower incidence of pneumothoraces ( 8.3 % vs. 37.5 % ; P=0.039 ) . The NPPV-treated group required a nurse workload similar to that of the conventional ventilation group , but this group had a shorter duration of stay in the ICU ( P=0.013 ) . The NPPV-treated group had a lower mortality in the ICU , the hospital and within 2 months of study entry . Differences in mortality between the two groups disappeared after 6 months . Conclusions : The findings of this study seem to provide further support for applying NPPV in AIDS patients with severe PCP-related ARF as a first-line therapeutic choice , but r and omized controlled trials are required to confirm our results CONTEXT Noninvasive ventilation ( NIV ) has been associated with lower rates of endotracheal intubation in population s of patients with acute respiratory failure . OBJECTIVE To compare NIV with st and ard treatment using supplemental oxygen administration to avoid endotracheal intubation in recipients of solid organ transplantation with acute hypoxemic respiratory failure . DESIGN AND SETTING Prospect i ve r and omized study conducted at a 14-bed , general intensive care unit of a university hospital . PATIENTS Of 238 patients who underwent solid organ transplantation from December 1995 to October 1997 , 51 were treated for acute respiratory failure . Of these , 40 were eligible and 20 were r and omized to each group . INTERVENTION Noninvasive ventilation vs st and ard treatment with supplemental oxygen administration . MAIN OUTCOME MEASURES The need for endotracheal intubation and mechanical ventilation at any time during the study , complications not present on admission , duration of ventilatory assistance , length of hospital stay , and intensive care unit mortality . RESULTS The 2 groups were similar at study entry . Within the first hour of treatment , 14 patients ( 70 % ) in the NIV group , and 5 patients ( 25 % ) in the st and ard treatment group improved their ratio of the PaO2 to the fraction of inspired oxygen ( FIO2 ) . Over time , a sustained improvement in PaO2 to FIO2 was noted in 12 patients ( 60 % ) in the NIV group , and in 5 patients ( 25 % ) r and omized to st and ard treatment ( P = .03 ) . The use of NIV was associated with a significant reduction in the rate of endotracheal intubation ( 20 % vs 70 % ; P = .002 ) , rate of fatal complications ( 20 % vs 50 % ; P = .05 ) , length of stay in the intensive care unit by survivors ( mean [ SD ] days , 5.5 [ 3 ] vs 9 [ 4 ] ; P = .03 ) , and intensive care unit mortality ( 20 % vs 50 % ; P = .05 ) . Hospital mortality did not differ . CONCLUSIONS These results indicate that transplantation programs should consider NIV in the treatment of selected recipients of transplantation with acute respiratory failure When treated with invasive endotracheal mechanical ventilation ( ETMV ) , acute respiratory insufficiency after lung resection is fatal in up to 80 % of cases . Noninvasive positive-pressure ventilation ( NPPV ) may reduce the need for ETMV , thereby improving survival . We conducted a r and omized prospect i ve trial to compare st and ard therapy with and without nasal-mask NPPV in patients with acute hypoxemic respiratory insufficiency after lung resection . The primary outcome variable was the need for ETMV and the secondary outcome variables were in-hospital and 120-d mortality rates , duration of stay in the intensive care unit , and duration of in-hospital stay . Twelve of the 24 patients ( 50 % ) r and omly assigned to the no-NPPV group required ETMV , versus only five of the 24 patients ( 20.8 % ) in the NPPV group ( p = 0.035 ) . Nine patients in the no-NPPV group died ( 37.5 % ) , and three ( 12.5 % ) patients in the NPPV group died ( p = 0.045 ) . The other secondary outcomes were similar in the two groups . NPPV is safe and effective in reducing the need for ETMV and improving survival after lung resection Abstract Objectives A prospect i ve survey of French intensive care units ( ICUs ) in 1997 showed moderate and variable use of noninvasive ventilation ( NIV ) . This study examined changes in NIV use in French ICUs after the intervening 5 years . Setting s Patients were enrolled in a prospect i ve survey in 70 French ICUs . Methods Three-week survey , with prospect i ve inclusion of all patients requiring  ventilatory support . Measurements and results Overall 1,076 patients received  ventilatory support  ( 55 % of admissions ) .  First-line NIV  was significantly more common than 5 years earlier , overall ( 23 % vs. 16 % ) and especially in patients not intubated before ICU admission ( 52 % vs. 35 % ) . Reasons for respiratory failure were coma ( 33 % ) , cardiogenic pulmonary edema ( 8 % ) , acute-on-chronic respiratory failure ( 17 % ) , and de novo respiratory failure ( 41 % ) . Significant increases in  NIV use were noted for acute-on-chronic respiratory failure ( 64 % vs. 50 % ) and de novo respiratory failure ( 22 % vs. 14 % ) . Among patients given NIV , 38 % subsequently required endotracheal intubation ( not significantly different ) . Independent risk factors for NIV failure were high SAPS II and de novo respiratory failure , whereas factors associated with success were good NIV tolerance and high body mass index . Conclusions NIV use has significantly increased in French ICUs during the past 5 years , and the success rate has remained unchanged . In patients not previously intubated , NIV is the leading first-line ventilation modality . The proportion of patients successfully treated with NIV increased significantly over the 5-year period ( 13 % vs. 9 % of all patients receiving ventilatory support ) BACKGROUND The need for reintubation after extubation and discontinuation of mechanical ventilation is not uncommon and is associated with increased mortality . Noninvasive positive-pressure ventilation has been suggested as a promising therapy for patients with respiratory failure after extubation , but a single-center , r and omized trial recently found no benefit . We conducted a multicenter , r and omized trial to evaluate the effect of noninvasive positive-pressure ventilation on mortality in this clinical setting . METHODS Patients in 37 centers in eight countries who were electively extubated after at least 48 hours of mechanical ventilation and who had respiratory failure within the subsequent 48 hours were r and omly assigned to either noninvasive positive-pressure ventilation by face mask or st and ard medical therapy . RESULTS A total of 221 patients with similar baseline characteristics had been r and omly assigned to either noninvasive ventilation ( 114 patients ) or st and ard medical therapy ( 107 patients ) when the trial was stopped early , after an interim analysis . There was no difference between the noninvasive-ventilation group and the st and ard-therapy group in the need for reintubation ( rate of reintubation , 48 percent in both groups ; relative risk in the noninvasive-ventilation group , 0.99 ; 95 percent confidence interval , 0.76 to 1.30 ) . The rate of death in the intensive care unit was higher in the noninvasive-ventilation group than in the st and ard-therapy group ( 25 percent vs. 14 percent ; relative risk , 1.78 ; 95 percent confidence interval , 1.03 to 3.20 ; P=0.048 ) , and the median time from respiratory failure to reintubation was longer in the noninvasive-ventilation group ( 12 hours vs. 2 hours 30 minutes , P=0.02 ) . CONCLUSIONS Noninvasive positive-pressure ventilation does not prevent the need for reintubation or reduce mortality in unselected patients who have respiratory failure after extubation BACKGROUND Noninvasive ventilation ( continuous positive airway pressure [ CPAP ] or noninvasive intermittent positive-pressure ventilation [ NIPPV ] ) appears to be of benefit in the immediate treatment of patients with acute cardiogenic pulmonary edema and may reduce mortality . We conducted a study to determine whether noninvasive ventilation reduces mortality and whether there are important differences in outcome associated with the method of treatment ( CPAP or NIPPV ) . METHODS In a multicenter , open , prospect i ve , r and omized , controlled trial , patients were assigned to st and ard oxygen therapy , CPAP ( 5 to 15 cm of water ) , or NIPPV ( inspiratory pressure , 8 to 20 cm of water ; expiratory pressure , 4 to 10 cm of water ) . The primary end point for the comparison between noninvasive ventilation and st and ard oxygen therapy was death within 7 days after the initiation of treatment , and the primary end point for the comparison between NIPPV and CPAP was death or intubation within 7 days . RESULTS A total of 1069 patients ( mean [ + /-SD ] age , 77.7+/-9.7 years ; female sex , 56.9 % ) were assigned to st and ard oxygen therapy ( 367 patients ) , CPAP ( 346 patients ) , or NIPPV ( 356 patients ) . There was no significant difference in 7-day mortality between patients receiving st and ard oxygen therapy ( 9.8 % ) and those undergoing noninvasive ventilation ( 9.5 % , P=0.87 ) . There was no significant difference in the combined end point of death or intubation within 7 days between the two groups of patients undergoing noninvasive ventilation ( 11.7 % for CPAP and 11.1 % for NIPPV , P=0.81 ) . As compared with st and ard oxygen therapy , noninvasive ventilation was associated with greater mean improvements at 1 hour after the beginning of treatment in patient-reported dyspnea ( treatment difference , 0.7 on a visual-analogue scale ranging from 1 to 10 ; 95 % confidence interval [ CI ] , 0.2 to 1.3 ; P=0.008 ) , heart rate ( treatment difference , 4 beats per minute ; 95 % CI , 1 to 6 ; P=0.004 ) , acidosis ( treatment difference , pH 0.03 ; 95 % CI , 0.02 to 0.04 ; P<0.001 ) , and hypercapnia ( treatment difference , 0.7 kPa [ 5.2 mm Hg ] ; 95 % CI , 0.4 to 0.9 ; P<0.001 ) . There were no treatment-related adverse events . CONCLUSIONS In patients with acute cardiogenic pulmonary edema , noninvasive ventilation induces a more rapid improvement in respiratory distress and metabolic disturbance than does st and ard oxygen therapy but has no effect on short-term mortality . ( Current Controlled Trials number , IS RCT N07448447 . Objectives To determine the effectiveness of noninvasive positive pressure ventilation ( NIPPV ) , and the factors predicting failure of NIPPV in acute respiratory failure ( ARF ) due to chronic obstructive pulmonary disease ( COPD ) versus other causes of ARF . Patients and methods This was a prospect i ve observational study and all patients with ARF requiring NIPPV over a one- and -a-half year period were enrolled in the study . We recorded the etiology of ARF and prospect ively collected the data for heart rate , respiratory rate , arterial blood gases ( pH , partial pressure of oxygen in the arterial blood [ PaO2 ] , partial pressure of carbon dioxide in arterial blood [ PaCO2 ] ) at baseline , one and four hours . The patients were further classified into two groups based on the etiology of ARF as COPD –ARF and ARF due to other causes . The primary outcome was the need for endotracheal intubation during the intensive care unit ( ICU ) stay . Results During the study period , 248 patients were admitted in the ICU and of these 63 ( 25.4 % ; 24 , COPD –ARF , 39 , ARF due to other causes ; 40 male and 23 female patients ; mean [ st and ard deviation ] age of 45.7 [ 16.6 ] years ) patients were initiated on  NIPPV .  Patients with ARF secondary to COPD were older , had higher APACHE II scores , lower respiratory rates , levels compared to other causes of ARF . After one hour there was lower pH and higher PaCO2 levels with increase a significant decrease in respiratory rate and heart rate and decline in PaCO2 levels in patients successfully managed with NIPPV . However , there was no in pH and PaO2 difference in improvement of clinical and blood gas parameters between the two groups except at one hour which was significantly the rate of decline of pH at one and four hours and PaCO2 faster in the COPD group . NIPPV failures were significantly higher in ARF due to other causes ( 15/39 ) than in ARF– COPD ( 3/24 ) ( p = 0.03 ) . The mean ICU and hospital stay and the hospital mortality were similar in the two groups . In the multivariate logistic regression model ( after and adjusting for gender , APACHE II scores and improvement in respiratory rate , pH , PaO2 at one hour ) only the etiology of ARF , ie , ARF– COPD , was associated with a decreased PaCO2 risk of  NIPPV  failure ( odds ratio 0.23 ; 95 % confidence interval , 0.58–0.9 ) . Conclusions NIPPV is more effective in preventing endotracheal intubation in ARF due to COPD than other causes , and the etiology of ARF is an important predictor of NIPPV failure Objective : In r and omized studies of heterogeneous patients with hypoxemic acute respiratory failure , noninvasive positive pressure ventilation ( NPPV ) was associated with a significant reduction in endotracheal intubation . The role of NPPV in patients with acute respiratory distress syndrome ( ARDS ) is still unclear . The objective was to investigate the application of NPPV as a first‐line intervention in patients with early ARDS , describing what happens in everyday clinical practice in centers having expertise with NPPV . Design : Prospect i ve , multiple‐center cohort study . Setting : Three European intensive care units having expertise with NPPV . Patients : Between March 2002 and April 2004 , 479 patients with ARDS were admitted to the intensive care units . Three hundred and thirty‐two ARDS patients were already intubated , so 147 were eligible for the study . Interventions : Application of NPPV . Measurements and Main Results : NPPV  improved gas exchange and avoided intubation in 79 patients ( 54 % ) . Avoidance of intubation was associated with less ventilator‐associated pneumonia ( 2 % vs. 20 % ; p < .001 ) and a lower intensive care unit mortality rate ( 6 % vs. 53 % ; p < .001 ) . Intubation was more likely in patients who were older ( p = .02 ) , had a higher Simplified Acute Physiology Score ( SAPS ) II ( p < .001 ) , or needed a higher level of positive end‐expiratory pressure ( p = .03 ) and pressure support ventilation ( p = .02 ) . Only SAPS II > 34 and a Pao2/Fio2 ≤175 after 1 hr of NPPV were independently associated with NPPV failure and need for endotracheal intubation . Conclusions : In expert centers , NPPV applied as first‐line intervention in ARDS avoided intubation in 54 % of treated patients . A SAPS II > 34 and the inability to improve Pao2/Fio2 after 1 hr of NPPV were predictors of failure CONTEXT Hypoxemia complicates the recovery of 30 % to 50 % of patients after abdominal surgery ; endotracheal intubation and mechanical ventilation may be required in 8 % to 10 % of cases , increasing morbidity and mortality and prolonging intensive care unit and hospital stay . OBJECTIVE To determine the effectiveness of continuous positive airway pressure compared with st and ard treatment in preventing the need for intubation and mechanical ventilation in patients who develop acute hypoxemia after elective major abdominal surgery . DESIGN AND SETTING R and omized , controlled , unblinded study with concealed allocation conducted between June 2002 and November 2003 at 15 intensive care units of the Piedmont Intensive Care Units Network in Italy . PATIENTS Consecutive patients who developed severe hypoxemia after major elective abdominal surgery . The trial was stopped for efficacy after 209 patients had been enrolled . INTERVENTIONS Patients were r and omly assigned to receive oxygen ( n = 104 ) or oxygen plus continuous positive airway pressure ( n = 105 ) . MAIN OUTCOME MEASURES The primary end point was incidence of endotracheal intubation ; secondary end points were intensive care unit and hospital lengths of stay , incidence of pneumonia , infection and sepsis , and hospital mortality . RESULTS Patients who received oxygen plus continuous positive airway pressure had a lower intubation rate ( 1 % vs 10 % ; P = .005 ; relative risk [ RR ] , 0.099 ; 95 % confidence interval [ CI ] , 0.01 - 0.76 ) and had a lower occurrence rate of pneumonia ( 2 % vs 10 % , RR , 0.19 ; 95 % CI , 0.04 - 0.88 ; P = .02 ) , infection ( 3 % vs 10 % , RR , 0.27 ; 95 % CI , 0.07 - 0.94 ; P = .03 ) , and sepsis ( 2 % vs 9 % ; RR , 0.22 ; 95 % CI , 0.04 - 0.99 ; P = .03 ) than did patients treated with oxygen alone . Patients who received oxygen plus continuous positive airway pressure also spent fewer mean ( SD ) days in the intensive care unit ( 1.4 [ 1.6 ] vs 2.6 [ 4.2 ] , P = .09 ) than patients treated with oxygen alone . The treatments did not affect the mean ( SD ) days that patients spent in the hospital ( 15 [ 13 ] vs 17 [ 15 ] , respectively ; P = .10 ) . None of those treated with oxygen plus continuous positive airway pressure died in the hospital while 3 deaths occurred among those treated with oxygen alone ( P = .12 ) . CONCLUSION Continuous positive airway pressure may decrease the incidence of endotracheal intubation and other severe complications in patients who develop hypoxemia after elective major abdominal surgery The benefit of noninvasive pressure support ventilation ( NIPSV ) in avoiding the need for endotracheal intubation and reducing morbidity and mortality associated with endotracheal intubation was evaluated in 41 patients who presented with acute respiratory failure not related to chronic obstructive pulmonary disease ( COPD ) . Patients were r and omly assigned to receive conventional therapy ( n = 20 ) or conventional therapy plus NIPSV ( n = 21 ) . NIPSV was delivered to the patient by a face mask connected to a ventilator ( Puritan-Bennett 7200a ) set in inspiratory pressure support ( IPS ) mode . The mean levels of IPS , positive end-expiratory pressure ( PEEP ) , and fraction of inspired oxygen ( FIO2 ) were respectively 15 + /- 3 cm H2O , 4 + /- 2 cm H2O , and 57 + /- 22 % . The rate of endotracheal intubation ( 62 vs 70 % , p = 0.88 ) , the length of ICU stay ( 17 + /- 19 days vs 25 + /- 23 days , p = 0.16 ) , and the mortality rate ( 33 vs 50 % , p = 0.46 ) were not different between patients treated with NIPSV and those treated conventionally . Post hoc analysis suggested that in patients with PaCO2 > 45 mm Hg ( n = 17 ) , NIPSV was associated with a reduction in the rate of endotracheal intubation ( 36 vs 100 % , p = 0.02 ) , in the length of ICU stay ( 13 + /- 15 days vs 32 + /- 30 days , p = 0.04 ) , and in the mortality rate ( 9 vs 66 % , p = 0.06 ) . We conclude that NIPSV is of no benefit when used systematic ally in all forms of acute respiratory failure not related to COPD . A subgroup of patients , characterized by acute ventilatory failure and hypercapnia , may potentially benefit from this therapy and further studies are needed to focus on this aspect BACKGROUND Avoiding intubation is a major goal in the management of respiratory failure , particularly in immunosuppressed patients . Nevertheless , there are only limited data on the efficacy of noninvasive ventilation in these high-risk patients . METHODS We conducted a prospect i ve , r and omized trial of intermittent noninvasive ventilation , as compared with st and ard treatment with supplemental oxygen and no ventilatory support , in 52 immunosuppressed patients with pulmonary infiltrates , fever , and an early stage of hypoxemic acute respiratory failure .  Periods of noninvasive ventilation delivered through a face mask were alternated every three hours with periods of spontaneous breathing with supplemental oxygen . The ventilation periods lasted at least 45 minutes . Decisions to intubate were made according to st and ard , predetermined criteria . RESULTS The base-line characteristics of the two groups were similar ; each group of 26 patients included 15 patients with hematologic cancer and neutropenia . Fewer patients in the noninvasive-ventilation group than in the st and ard-treatment group required endotracheal intubation ( 12 vs. 20 , P=0.03 ) , had serious complications ( 13 vs. 21 , P=0.02 ) , died in the intensive care unit ( 10 vs. 18 , P=0.03 ) , or died in the hospital ( 13 vs. 21 , P=0.02 ) . CONCLUSIONS In selected immunosuppressed patients with pneumonitis and acute respiratory failure , early initiation of noninvasive ventilation is associated with significant reductions in the rates of endotracheal intubation and serious complications and an improved likelihood of survival to hospital discharge The efficacy of noninvasive ventilation ( NIV ) to avoid intubation and improve survival was assessed in 105 patients with severe acute hypoxemic respiratory failure ( arterial O2 tension or saturation persistently 60 mm Hg or less or 90 % or less , respectively ; breathing conventional Venturi oxygen at a maximal concentration [ 50 % ] ) , excluding hypercapnia , admitted into intensive care units of three hospitals . Patients were r and omly allocated within 24 hours of fulfilling inclusion criteria to receive NIV ( n=51 ) or high-concentration oxygen therapy ( n=54 ) . The primary end-point variable was the decrease in the intubation rate . Both groups had similar characteristics . Compared with oxygen therapy , NIV decreased the need for intubation ( 13 , 25 % vs. 28 , 52 % , p=0.010 ) , the incidence of septic shock ( 6 , 12 % vs. 17 , 31 % , p=0.028 ) , and the intensive care unit mortality ( 9 , 18 % vs. 21 , 39 % , p=0.028 ) and increased the cumulative 90-day survival ( p=0.025 ) . The improvement of arterial hypoxemia and tachypnea was higher in the noninvasive ventilation group with time ( p=0.029 each ) . Multivariate analyses showed NIV to be independently associated with decreased risks of intubation ( odds ratio , 0.20 ; p=0.003 ) and 90-day mortality ( odds ratio , 0.39 ; p=0.017 ) . The use of noninvasive ventilation prevented intubation , reduced the incidence of septic shock , and improved survival in these patients compared with high-concentration oxygen therapy CONTEXT Noninvasive positive-pressure ventilation ( NPPV ) has been demonstrated to be effective in preventing the need for endotracheal intubation in some patients who present with acute respiratory failure . It is also used for patients who develop acute respiratory distress after extubation , but there are no r and omized controlled trials that address its effectiveness in this population . OBJECTIVE To determine the effectiveness of NPPV compared with st and ard medical therapy in preventing the need for endotracheal reintubation in high-risk patients who develop respiratory distress during the first 48 hours after extubation . DESIGN R and omized , controlled , unblinded study with concealed allocation conducted between August 1 , 1996 and October 31 , 1999 . SETTING An intensive care unit ( ICU ) in an academic , tertiary care hospital in Ontario . PATIENTS Eighty-one patients with a history of cardiac or respiratory disease or who initially required ventilatory support for more than 2 days and who developed respiratory distress within 48 hours of extubation . INTERVENTIONS Patients were r and omly assigned to receive st and ard medical therapy alone ( supplemental oxygen to maintain oxygen saturation by pulse oximetry > or = 95 % ; n = 42 ) or NPPV by face mask plus st and ard medical therapy ( n = 39 ) . MAIN OUTCOME MEASURES Rates of reintubation , duration of mechanical ventilation , lengths of ICU and hospital stay , and hospital mortality . RESULTS Comparing the NPPV group with the st and ard-therapy group , there was no difference in the rate of reintubation ( 72 % vs 69 % ; relative risk , 1.04 ; 95 % confidence interval , 0.78 - 1.38 ) or hospital mortality ( 31 % for both groups ; relative risk , 0.99 ; 95 % confidence interval , 0.52 - 1.91 ) . Similarly , no difference was found in duration of mechanical ventilation or length of ICU or hospital stay . CONCLUSIONS The addition of NPPV to st and ard medical therapy does not improve outcome in heterogeneous groups of patients who develop respiratory distress during the first 48 hours after extubation
Non-invasive ventilation ( NIV ) has been widely supported in the past two decades as an effective application in avoiding the need for endotracheal intubation ( ETI ) and reducing associated mortality in acute hypoxemic respiratory failure ( AHRF ) patients .
However , the efficacy of NIV in AHRF patients , non-related to chronic obstructive pulmonary disease ( COPD ) and trauma is still controversial in the field of medical research .
This retrospective study aim ed to evaluate the efficacy of NIV as an adjunctive therapy in non- COPD and non-traumatic AHRF patients .