Noninvasive ventilation in immunosuppressed patients with pulmonary infiltrates, fever, and acute respiratory failure.

Background: Avoiding intubation is a major goal in the management of respir atory failure, particularly in immunosuppressed patients. Nevertheless, the re are only limited data on the efficacy of noninvasive ventilation in thes e high-risk patients. Methods: We conducted a prospective, randomized trial of intermittent nonin vasive ventilation, as compared with standard treatment with supplemental o xygen and no ventilatory support, in 52 immunosuppressed patients with pulm onary infiltrates, fever, and an early stage of hypoxemic acute respiratory failure. Periods of noninvasive ventilation delivered through a face mask were alternated every three hours with periods of spontaneous breathing wit h supplemental oxygen. The ventilation periods lasted at least 45 minutes. Decisions to intubate were made according to standard, predetermined criter ia. Results: The base-line characteristics of the two groups were similar; each group of 26 patients included 15 patients with hematologic cancer and neut ropenia. Fewer patients in the noninvasive-ventilation group than in the st andard-treatment group required endotracheal intubation (12 vs. 20, P=0.03) , had serious complications (13 vs. 21, P=0.02), died in the intensive care unit (10 vs. 18, P=0.03), or died in the hospital (13 vs. 21, P=0.02). Conclusions: In selected immunosuppressed patients with pneumonitis and acu te respiratory failure, early initiation of noninvasive ventilation is asso ciated with significant reductions in the rates of endotracheal intubation and serious complications and an improved likelihood of survival to hospita l discharge. (N Engl J Med 2001;344:481-7.) Copyright (C) 2001 Massachusett s Medical Society.