Noninvasive Ventilation in Severe Hypoxemic Respiratory Failure

Abstract

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 randomly 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.

Bi-level Versus Continuous Positive Airway Pressure in Acute Cardiogenic Pulmonary Edema: A Randomized Control Trial

“…Moreover, Gray et al, [24] did not find the difference in intubation or mortality rates with either CPAP or Bi-PAP compared to oxygen therapy. In contrast, previous trials [21,25] found that Bi-PAP reduced the need for invasive mechanical ventilation, and endotracheal intubation when compared with oxygen therapy.…”

Neurally adjusted ventilatory assist (NAVA) improves patient–ventilator interaction during non-invasive ventilation delivered by face mask

“…Finally, the number of included patients was small and as our group of patients included those admitted for acute respiratory failure and those at risk of developing respiratory failure after extubation, the group was heterogeneous. Nonetheless, despite this heterogeneity, all patients received NIV for well-validated indications [3,17,18]. It must also be pointed out that our study was a short-term evaluation and that the included patients were not in severe respiratory distress.…”

“…Intensive care patients receiving NIV via an oronasal face mask for acute respiratory failure [17,18] or for being at risk of postextubation respiratory failure according to previously published criteria [3] were eligible for inclusion in the study. Exclusion criteria are outlined in the Electronic Supplementary Material.…”

Non-invasive ventilation in hypoxemic acute respiratory failure: is it still possible?

“…Non-invasive ventilation has been demonstrated to be beneficial for the outcome of patients with acute exacerbation of chronic obstructive pulmonary disease, acute cardiogenic pulmonary oedema, and more recently in the weaning/post-extubation management oe ARF. Non-invasive ventilation can also prevent intubation in selected patients with severe hypoxemic or de novo ARF [3], particularly in the postoperative period [4]. However, its clinical benefit remains controversial for the management of hypoxemic patients [5].…”

“…In fact, several factors (Table 1) may explain the discrepancy of NIV results in hypoxemic ARF, with a failure rate (intubation) ranging from 25 to 60% [3] and an intensive care unit (ICU) mortality rate after intubation reaching up to 60% [8]. Heterogeneity in the underlying aetiology and severity of ARF is probably one of the main confounding factors.…”