RANDOMIZED, PROSPECTIVE TRIAL OF NONINVASIVE POSITIVE PRESSURE VENTILATION IN ACUTE RESPIRATORY-FAILURE

Recent studies suggest that noninvasive positive pressure ventilation (NPPV) administered by nasal or oronasal mask avoids the need for endo tracheal intubation, rapidly improves vital signs, gas exchange, and s ense of dyspnea, and may reduce mortality in selected patients with ac ute respiratory failure, but few controlled trials have been done. The present study used a randomized prospective design to evaluate the po ssible benefits of NPPV plus standard therapy versus standard therapy alone in patients with acute respiratory failure. Patients to receive NPPV were comfortably fitted with a standard nasal mask connected to a BIPAP ventilatory assist device (Respironics, Inc., Murrysville, PA) in the patient flow-triggered/time-triggered (S/T) mode, and standard therapy consisted of all other treatments deemed necessary by the prim ary physician, including endotracheal intubation. The need for intubat ion was reduced from 73% in the standard therapy group (11 of 15 patie nts) to 31% in the NPPV group (5 of 16 patients, p < 0.05). Among chro nic obstructive pulmonary disease (COPD) patients, the reduction was e ven more striking, with 8 of 12 (67%) control patients requiring intub ation compared with 1 of 11 (9%) NPPV patients fp < 0.05). Heart and r espiratory rates were significantly lower in the NPPV group than in co ntrol patients within 1 h, and PaO2 was significantly improved in the NPPV group for the first 6 h. Dyspnea scores and maximal inspiratory p ressures were better in the NPPV than in control patients at 6 h, and nurses and therapists spent similar amounts of time at the bedside for both groups. Duration of ventilator use, hospital stays, mortality ra tes, and hospital charges were also similar Nasal NPPV was well tolera ted, and complications were few and minor. We conclude that nasal NPPV reduces the need for intubation in patients with acute respiratory in sufficiency who are otherwise stable, particularly those with COPD.