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Published ahead of print on September 18, 2003, doi:10.1164/rccm.200301-072OC

Am. J. Respir. Crit. Care Med., Volume 168, Number 12, December 2003, 1438-1444

A more recent version of this article appeared on December 15, 2003
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Submitted on January 17, 2003
Accepted on September 17, 2003

NON-INVASIVE VENTILATION IN SEVERE HYPOXEMIC RESPIRATORY FAILURE. A RANDOMIZED CLINICAL TRIAL

Miquel Ferrer1*, Antonio Esquinas2, Miguel Leon3, Gumersindo Gonzalez2, Antonio Alarcon1, and Antoni Torres1

1 Institut Clinic de Pneumologia i Cirurgia Toracica, Universitat de Barcelona, Hospital Clinic, Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain, 2 Unidad de Cuidados Intensivos, Hospital Morales Meseguer, Murcia, Spain, 3 Unidad de Cuidados Intensivos, Hospital Arnau de Vilanova, Lleida, Spain

* To whom correspondence should be addressed. E-mail: miferrer{at}clinic.ub.es.

The efficacy of non-invasive ventilation in order to avoid intubation and improve survival was assessed in 105 patients with severe acute hypoxemic respiratory failure (arterial O2 tension or saturation persistently <=60 mmHg or <=90%, respectively, breathing conventional Venturi oxygen at maximal concentration (50%), excluding hypercapnia, admitted into intensive care units of 3 hospitals. Patients were randomly allocated within 24 hours of fulfilling inclusion criteria to receive non-invasive ventilation (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, non-invasive ventilation 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 non-invasive-ventilation group with time (p=0.029 each). Multivariate analyses showed non-invasive ventilation 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 non-invasive ventilation prevented intubation, reduced the incidence of septic shock, and improved survival in these patients, compared with high concentration oxygen therapy.
Key words: Acute respiratory failure, Intensive care unit, Noninvasive ventilation, Controlled clinical trial




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