Non-invasive ventilation versus invasive mechanical ventilation in patients with hypoxemic acute respiratory failure in an Intensive Care Unit. A randomized controlled study
Por:
Belenguer-Muncharaz A, Cubedo-Bort M, Blasco-Asensio D, Mateu-Campos L, Vidal-Tegedor B, Madero-Perez J, Ferrandiz-Selles A
Publicada:
1 mar 2017
Resumen:
BACKGROUND: The aim of this study was to assess the efficacy of non-invasive ventilation (NIV) as a possible alternative to invasive mechanical ventilation (IMV) in hypoxemic acute respiratory failure (ARF).
METHODS: A randomized controlled study carried out in an Intensive Care Unit (ICU) between June 2001 and July 2006. The primary endpoint was the reduction of ICU mortality in the NIV group vs. IMV group. The secondary endpoints included rate of endotracheal intubation, improvement of oxygenation, hemodinamics variation along ventilation, duration of mechanical ventilation, ICU and hospital length of stays, mortality at hospital and 90d after ICU admission, complication rates and ICU mortality related factors.
RESULTS: From 215 hypoxemic ARF patients, 65 patients were studied (34 were assigned to NIV and 31 to IMV). ICU Mortality rate was 38% in NIV vs. 22% in IMV, P=0.19. Intubation was required in 19 (56%) patients who failured NIV. In NIV group showed a shorter duration of ventilation [4(2-8) days vs. 14 (9-20) days in IMV group, P=0.001)] and shorter ICU stay [6 (3-12) days vs. 20 (12-25) days in IMV group, P=0.001)] than IMV group. The NIV group also had fewer ventilator-associated pneumonia (15% vs. 74% in IMV group, P<0.001) and cardiovascular failure (18% vs. 83% in IMV group, P<0.001). NIV failure was determinated as ICU mortality factor [RR 5.95 (CI95% 1.13 to 23.24, P=0.034)].
CONCLUSIONS: Considering the advantages and disadvantages of NIV, we believe NIV could be a reasonable option in hypoxemic ARF patients.
Filiaciones:
Belenguer-Muncharaz A:
Hosp Gen Univ Castellon, Intens Care Unit, Castellon de La Plana, Spain
Jaume I Castello Univ, Predept Unit Med, Fac Hlth Sci, Castellon de La Plana, Spain
Cubedo-Bort M:
Consorcio Hosp Prov Castellon, Intens Care Unit, Castellon de La Plana, Spain
Blasco-Asensio D:
Publ Hlth Ctr, Epidemiol Unit, Benicarlo, Spain
Mateu-Campos L:
Hosp Gen Univ Castellon, Intens Care Unit, Castellon de La Plana, Spain
Jaume I Castello Univ, Predept Unit Med, Fac Hlth Sci, Castellon de La Plana, Spain
Vidal-Tegedor B:
Hosp Gen Univ Castellon, Intens Care Unit, Castellon de La Plana, Spain
Madero-Perez J:
Consorcio Hosp Prov Castellon, Intens Care Unit, Castellon de La Plana, Spain
Ferrandiz-Selles A:
Hosp Gen Univ Castellon, Intens Care Unit, Castellon de La Plana, Spain
Jaume I Castello Univ, Predept Unit Med, Fac Hlth Sci, Castellon de La Plana, Spain
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