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Minerva Pneumologica 2017 March;56(1):1-10

DOI: 10.23736/S0026-4954.16.01770-3

Copyright © 2016 EDIZIONI MINERVA MEDICA

language: English

Non-invasive ventilation versus invasive mechanical ventilation in patients with hypoxemic acute respiratory failure in an Intensive Care Unit. A randomized controlled study

Alberto BELENGUER-MUNCHARAZ 1, 2, Manuel CUBEDO-BORT 3, David BLASCO-ASENSIO 4, Lidón MATEU-CAMPOS 1, 2, Bárbara VIDAL-TEGEDOR 1, Javier MADERO-PÉREZ 3, Amparo FERRÁNDIZ-SELLÉS 1, 2

1 Intensive Care Unit, Hospital General Universitario de Castellón, Castelló de la Plana, Spain; 2 Predepartmental Unit Medicine, Faculty Health Sciences, Jaume I de Castelló Universty, Castelló de la Plana, Spain; 3 Intensive Care Unit, Consorcio Hospitalario Provincial of Castellón, Castelló de la Plana, Spain; 4 Epidemiology Unit, Public Health Center, Benicarló, Spain


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BACKGROUND: The aim of this study was to assess the efficacy of non-invasive ventilation (NIV) as a possible alternative to invasive mechanical ventilation (IMV) in hypoxemic acute respiratory failure (ARF).
METHODS: A randomized controlled study carried out in an Intensive Care Unit (ICU) between June 2001 and July 2006. The primary endpoint was the reduction of ICU mortality in the NIV group vs. IMV group. The secondary endpoints included rate of endotracheal intubation, improvement of oxygenation, hemodinamics variation along ventilation, duration of mechanical ventilation, ICU and hospital length of stays, mortality at hospital and 90d after ICU admission, complication rates and ICU mortality related factors.
RESULTS: From 215 hypoxemic ARF patients, 65 patients were studied (34 were assigned to NIV and 31 to IMV). ICU Mortality rate was 38% in NIV vs. 22% in IMV, P=0.19. Intubation was required in 19 (56%) patients who failured NIV. In NIV group showed a shorter duration of ventilation [4(2-8) days vs. 14 (9-20) days in IMV group, P=0.001)] and shorter ICU stay [6 (3-12) days vs. 20 (12-25) days in IMV group, P=0.001)] than IMV group. The NIV group also had fewer ventilator-associated pneumonia (15% vs. 74% in IMV group, P<0.001) and cardiovascular failure (18% vs. 83% in IMV group, P<0.001). NIV failure was determinated as ICU mortality factor [RR 5.95 (CI95% 1.13 to 23.24, P=0.034)].
CONCLUSIONS: Considering the advantages and disadvantages of NIV, we believe NIV could be a reasonable option in hypoxemic ARF patients.


KEY WORDS: Respiration, artificial - Noninvasive ventilation - Respiratory insufficiency – Pneumonia - Respiratory distress syndrome, adult

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