A COMPARISON OF NONINVASIVE POSITIVE-PRESSURE VENTILATION AND CONVENTIONAL MECHANICAL VENTILATION IN PATIENTS WITH ACUTE RESPIRATORY-FAILURE

Background and Methods The role of noninvasive positive-pressure venti lation delivered through a face mask in patients with acute respirator y failure is uncertain. We conducted a prospective, randomized trial o f noninvasive positive-pressure ventilation as compared with endotrach eal intubation with conventional mechanical ventilation in 64 patients with hypoxemic acute respiratory failure who required mechanical vent ilation. Results Within the first hour of ventilation, 20 of 32 patien ts (62 percent) in the noninvasive-ventilation group and 15 of 32 (47 percent) in the conventional-ventilation group had an improved ratio o f the partial pressure of arterial oxygen to the fraction of inspired oxygen (PaO2:FiO(2)) (P=0.21). Ten patients in the noninvasive-ventila tion group subsequently required endotracheal intubation. Seventeen pa tients in the conventional-ventilation group (53 percent) and 23 in th e noninvasive-ventilation group (72 percent) survived their stay in th e intensive care unit (odds ratio, 0.4; 95 percent confidence interval , 0.1 to 1.4; P = 0.19); 16 patients in the conventional-ventilation g roup and 22 patients in the noninvasive-ventilation group were dischar ged from the hospital. More patients in the conventional-ventilation g roup had serious complications (66 percent vs. 38 percent, P = 0.02) a nd had pneumonia or sinusitis related to the endotracheal tube (31 per cent vs. 3 percent, P = 0.003). Among the survivors, patients in the n oninvasive-ventilation group had shorter periods of ventilation (P = 0 .006) and shorter stays in the intensive care unit (P = 0.002). Conclu sions In patients with acute respiratory failure, noninvasive ventilat ion was as effective as conventional ventilation in improving gas exch ange and was associated with fewer serious complications and shorter s tays in the intensive care unit. (N Engl J Med 1998;339:429-35.) (C)19 98, Massachusetts Medical Society.