Noninvasive ventilation for treatment of acute respiratory failure in patients undergoing solid organ transplantation - A randomized trial

Context Noninvasive ventilation (NIV) has been associated with lower rates of endotracheal intubation in populations of patients with acute respirator y failure. Objective To compare NIV with standard treatment using supplemental oxygen administration to avoid endotracheal intubation in recipients of solid orga n transplantation with acute hypoxemic respiratory failure. Design and Setting Prospective randomized study conducted at a 14-bed, gene ral intensive care unit of a university hospital. Patients Of 238 patients who underwent solid organ transplantation from Dec ember 1995 to October 1997, 51 were treated for acute respiratory failure. Of these, 40 were eligible and 20 were-randomized to each group. Intervention Noninvasive ventilation vs standard treatment with supplementa l oxygen administration. Main Outcome Measures The need for endotracheal intubation and mechanical v entilation at any time during the study, complications not present on admis sion, duration of ventilatory assistance, length of hospital stay, and inte nsive care unit mortality. Results The 2 groups were similar at study entry. Within the first hour of treatment, 14 patients (70%) in the NIV group, and 5 patients (25%) in the standard treatment group improved their ratio of the PaO2 to the fraction o f inspired oxygen (FIO2). Over time, a sustained improvement in PaO2 to FIO 2 was noted in 12 patients (60%) in the NIV group, and in 5 patients (25%) randomized to standard treatment (P = .03). The use of NIV was associated w ith a significant reduction in the rate of endotracheal intubation (20% vs 70%, P = .002), rate of fatal complications (20% vs 50%, P = .05), length o f stay in the intensive care unit by survivors (mean [SD] days, 5.5 [3] vs 9 [4]; P = .03), and intensive care unit mortality (20% vs 50%; P = .05), H ospital mortality did not differ. Conclusions These results indicate,that transplantation programs should con sider NIV in the treatment of selected recipients of transplantation with a cute respiratory failure.