Intermittent Noninvasive Ventilation Can Decrease Mortality

Noninvasive ventilatory support has been advocated as an alternative to endotracheal intubation in patients with impending or actual respiratory failure. This prospective, randomized trial evaluated intermittent ventilatory support for immunosuppressed patients with severe respiratory distress.

All patients had pulmonary infiltrates, fever, dyspnea, respiratory rate of more than 30, and impairment of oxygenation. Patients who required emergency intubation at presentation or who had COPD, cardiac ischemia, or acute pulmonary edema were excluded. Also excluded were patients with multi-organ failure, altered mental status, pCO₂ over 55 mm Hg, or systolic BP less than 80 mm Hg.

Fifty-two patients met the study criteria. Of these, 26 were randomiz…