Noninvasive respiratory ventilation in severe hypoxemic failure - A randomized clinical trial

The efficacy of noninvasive ventilation (NIV) to avoid intubation and improve survival was assessed in 105 patients with severe acute hypoxemic respiratory failure (arterial O-2 tension or saturation persistently 60 mm Hg or less or 90% or less, respectively; breathing conventional Venturi oxygen at a maximal concentration [50%]), excluding hypercapnia, admitted into intensive care units of three hospitals. Patients were randomly allocated within 24 hours of fulfilling inclusion criteria to receive NIV (n = 51) or high-concentration oxygen therapy (n = 54). The primary end-point variable was the decrease in the intubation rate. Both groups had similar characteristics. Compared with oxygen therapy, NIV decreased the need for intubation (113, 25% vs. 28, 52%, p = 0.010), the incidence of septic shock (6, 12% vs. 17, 31%, p = 0.028), and the intensive care unit mortality (9, 18% vs. 21, 39%, p = 0.028) and increased the cumulative 90-day survival (p = 0.025). The improvement of arterial hypoxemia and tachypnea was higher in the noninvasive ventilation group with time (p = 0.029 each). Multivariate analyses showed NIV to be independently associated with decreased risks of intubation (odds ratio, 0.20; p = 0.003) and 90-day mortality (odds ratio, 0.39; p = 0.017). The use of noninvasive ventilation prevented intubation, reduced the incidence of septic shock, and improved survival in these patients compared with high-concentration oxygen therapy.