Non-Invasive Ventilation

To determine whether noninvasive ventilation is of benefit for treating cardiogenic pulmonary edema in the emergency department, Nava and coworkers did a multicenter, randomized trial in 130 patients in acute respiratory failure secondary to cardiogenic pulmonary edema. Compared with medical therapy and supplemental oxygen, noninvasive ventilation with pressure support achieved more rapid improvements in dyspnea, respiratory rate, and Pa_O₂/FI_O₂ ratio. The rate of intubation, duration of hospital stay, and hospital mortality were equivalent for the two groups. In the subgroup of patients with hypercapnia, noninvasive ventilation achieved more rapid improvement in PCO₂ than did standard therapy, and also decreased the rate of intubation: 6 versus 29%. Adverse effects, including myocardial infarction, were evenly distributed in the two groups. The authors conclude that use of noninvasive ventilation for the treatment of acute respiratory failure secondary to cardiogenic pulmonary edema in the emergency department achieves more rapid improvements in dyspnea, respiratory rate, and arterial oxygenation, without affecting intubation rate or mortality, although intubation rate is decreased in the subgroup of patients with hypercapnia. An editorial commentary by Bersten accompanies this article.

To determine whether use of noninvasive ventilation is beneficial for the treatment of acute hypoxemic respiratory failure, Ferrer and coworkers did a randomized trial in 105 patients with severe hypoxemia (PO₂ less than 60 mm Hg or oxygen saturation less than 90% while breathing an oxygen concentration of 50%). Compared with oxygen therapy, noninvasive ventilation decreased the need for intubation (13.3% versus 28.5%), incidence of septic shock (6.1% versus 17.3%), and ICU mortality (9.2% versus 21.4%); 90-day survival was also increased. Noninvasive ventilation achieved a greater improvement in PO₂ and respiratory rate over time. On multivariate analysis, noninvasive ventilation was independently associated with decreased risk of intubation and decreased 90-day mortality. The authors conclude that use of noninvasive ventilation in patients with acute hypoxemic respiratory failure decreased the rate of intubation and septic shock and improved survival as compared with high-concentration oxygen-therapy.

Ferrer and coworkers randomized 43 patients who failed trials of spontaneous breathing on three consecutive days to extubation plus noninvasive ventilation or to continued intubation plus daily spontaneous breathing trials. The trial was stopped early because the end-point was reached after studying half the planned study population. Compared with conventional weaning, patients weaned with noninvasive ventilation had a shorter duration of invasive ventilation (9.5 versus 20.1 days), shorter stay in ICU (14.1 versus 25.0 days), shorter hospital stay (27.8 versus 40.8 days), less need for tracheotomy (1.5 versus 13.6%), lower incidence of nosocomial pneumonia (5.2 versus 13.6%), lower incidence of septic shock (2.1 versus 9.4%), greater ICU survival (19.9 versus 13.6%), and greater 90-day survival (about 75% versus 40%). Conventional weaning was independently associated with decreased ICU survival (odds ratio, 6.6) and decreased 90-day survival (odds ratio, 3.5). The authors conclude that use of noninvasive ventilation in patients who fail three consecutive days of conventional weaning results in shorter duration of mechanical ventilation, fewer complication, less need for tracheotomy, and increased ICU and 90-day survival. An editorial commentary by Navalesi and coworkers accompanies this article.

Citations 1-5 of 5 total displayed.

Noninvasive Ventilation for Cardiogenic Pulmonary Edema: Froth and Bubbles?

Andrew D. Bersten
Am. J. Respir. Crit. Care Med. 168: 1406-1408. [Full text]

Noninvasive Ventilation in Cardiogenic Pulmonary Edema: A Multicenter Randomized Trial

Stefano Nava, Giorgio Carbone, Nicola DiBattista, Andrea Bellone, Paola Baiardi, Roberto Cosentini, Mauro Marenco, Fabrizio Giostra, Guido Borasi, and Paolo Groff
Am. J. Respir. Crit. Care Med. 168: 1432 -1437. First published online as doi:10.1164/rccm.200211-1270OC [Abstract] [Full text]

Noninvasive Ventilation in Severe Hypoxemic Respiratory Failure: A Randomized Clinical Trial

Miquel Ferrer, Antonio Esquinas, Miguel Leon, Gumersindo Gonzalez, Antonio Alarcon, and Antoni Torres
Am. J. Respir. Crit. Care Med. 168: 1438 -1444. First published online as doi:10.1164/rccm.200301-072OC [Abstract] [Full text]

Weaning and Noninvasive Ventilation: The Odd Couple

Paolo Navalesi
Am. J. Respir. Crit. Care Med. 168: 5-6. [Full text]

Noninvasive Ventilation during Persistent Weaning Failure: A Randomized Controlled Trial

Miquel Ferrer, Antonio Esquinas, Francisco Arancibia, Torsten Thomas Bauer, Gumersindo Gonzalez, Andres Carrillo, Robert Rodriguez-Roisin, and Antoni Torres
Am. J. Respir. Crit. Care Med. 168: 70 -76. First published online as doi:10.1164/rccm.200209-1074OC [Abstract] [Full text]

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