A randomized, prospective evaluation of noninvasive ventilation for acute respiratory failure

We compared noninvasive positive-pressure ventilation (NPPV), using bilevel positive airway pressure, with usual medical care (UMC) in the therapy of patients with acute respiratory failure (ARF) in a prospective, randomized trial. Patients were subgrouped according to the disease leading to ARF (ch ronic obstructive pulmonary disease [COPD], a non-COPD-related pulmonary pr ocess, neuromuscular disease, and status postextubation), and were then ran domized to NPPV or UMC. Thirty-two patients were evaluated in the NPPV grou p and 29 in the UMC group. The rate of endotracheal intubation (ETI) was si gnificantly lower in the NPPV than in the UMC group (6.38 intubations versu s 21.25 intubations per 100 ICU days, p = 0.002). Mortality rates in the in tensive care unit (ICU) were similar for the two treatment groups (2.39 dea ths versus 4.27 deaths per 100 ICU days, p = 0.21, NPPV versus UMC, respect ively). Patients with hypoxemic ARF in the NPPV group had a significantly l ower ETI rate than those in the UMC group (7.46 intubations versus 22.64 in tubations per 100 ICU days, p = 0.026); a similar trend was noted for patie nts with hypercapnic ARF (5.41 intubations versus 18.52 intubations per 100 ICU days, p = 0.064 NPPV versus UMC, respectively). Patients with ARF in t he non-COPD category had a lower rate of ETI with NPPV than with UMC (8.45 intubations versus 30.30 intubations per 100 ICU days, p = 0.01). Although the rate of ETI was lower among COPD patients receiving NPPV, this trend di d not reach statistical significance (5.26 intubations versus 15.63 intubat ions per 100 ICU days, p = 0.12, NPPV versus UMC, respectively). In conclus ion, NPPV with bilevel positive airway pressure reduces the rate of ETI in patients with ARF of various etiologies.