No Clear Benefit of Early NPPV in Immunocompromised Patients with Hypoxemic Respiratory Failure

In a small trial conducted in the late 1990s, early use of noninvasive positive-pressure ventilation (NPPV) conferred a mortality benefit in immunocompromised patients with hypoxemic respiratory failure (NEJM JW Emerg Med Jun 2001 and N Engl J Med 2001; 344:481). Since then, outcomes in critically ill patients have improved dramatically, and more clinicians have begun to wonder whether early NPPV still is warranted.

In this multicenter trial, investigators in France randomized 374 immunocompromised patients in intensive care units to either NPPV or oxygen therapy during the early stages of hypoxemic respiratory failure. Patients had hypoxemia, tachypnea, labored breathing, or respiratory distress; those with hypercarbia or immediate need for…