Noninvasive mechanical ventilation better for acute respiratory failure
Noninvasive mechanical ventilation is a better treatment option than invasive mechanical ventilation for immunocompromised patients with acute respiratory failure who are less severe, according to recent study data.
“In spite of better antimicrobial agents and preventive measures, infections continue to be one of the most frequent complications in immunocompromised patients and have a high mortality rate of 30% to 90%, with the highest when acute respiratory failure occurs,” Tao Wang, of Peking Union Medical College Hospital in Beijing, China, and colleagues wrote. “Noninvasive mechanical ventilation and invasive mechanical ventilation are two approaches for providing supplemental oxygen for patients with relatively severe acute respiratory failure.”
However, the appropriate choice for relatively severe acute respiratory failure had not been determined.
Wang and colleagues performed a database search and subgroup evaluations on disease severity and causes of immunodeficiency to determine the influence of noninvasive mechanical ventilation compared with invasive mechanical ventilation on clinical outcomes in immunocompromised patients with acute respiratory failure.
The analysis included 2,552 patients from 13 observational studies.
Data indicated that patients treated with noninvasive mechanical ventilation had significantly reduced rates of in-hospital mortality (OR 0.43; 95% CI, 0.23-0.80; P = 0.007), as well as 30-day mortality (OR 0.34; 95% CI, 0.20-0.61; P < 0.0001) compared with those treated with invasive mechanical ventilation.
In addition, mortality and ICU stay duration was significantly reduced for less severe, AIDS, bone marrow transplantation and hematological malignancies subgroups treated with noninvasive mechanical ventilation.
For more severe patients, noninvasive mechanical ventilation did not prove more beneficial, but also did not show any harm to patients.
“The overall evidence we obtained supports noninvasive mechanical ventilation over invasive mechanical ventilation in treating acute respiratory failure in certain group of immunocompromised patients,” Wang and colleagues concluded. “Future studies need to be methodologically sound and include patients immunocompromised by other causes such as chemotherapy and receipt of glucocorticoids.” – by Alaina Tedesco
Disclosure: The researchers report no relevant financial disclosures.