1. Home>
2. Specialties>
3. General Medicine>
4. Summary and Comment

NONINVASIVE VENTILATION REDUCES NEED FOR INTUBATION.

There is growing evidence that noninvasive ventilation may reduce the need for endotracheal intubation in some patients with respiratory failure. This trial from Europe randomized 85 patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) to either standard treatment (e.g., oxygen, bronchodilators) or standard treatment plus noninvasive pressure-support ventilation delivered through a face mask. All patients had at least two of the following: a respiratory rate above 30 breaths/min, a PaO2 below 45 mm Hg, and arterial pH below 7.35 on room air. The mean baseline arterial blood gas values were pH, 7.28; PaO2, 40 mm Hg; and PaCO2, 69 mm Hg. Patients with an immediate need for intubation and those with complicating illnesses were excluded. Compared with controls, patients receiving noninvasive ventilation were significantly less likely to be intubated (26 vs. 74 percent). The noninvasive ventilation group also had significant reductions in complications, length of hospital stay, and in-hospital mortality (9 vs. 29 percent). Comment: This is the second randomized trial to support the use of noninvasive ventilation in selected cases of acute COPD exacerbation (see Journal Watch accession number 930706005 and Lancet 1993; 341:1555). An editorialist believes that noninvasive ventilation should become part of the "first-line treatment" for such patients.

— AS Brett

Published in Journal Watch General Medicine October 6, 1995

Citation(s):

Elliott MW. Noninvasive ventilation in chronic obstructive pulmonary disease. N Engl J Med 1995 Sep 28 333 870-871.

• Original article (Subscription may be required)
• Medline abstract (Free)

Brochard L, et al. Noninvasive ventilation for acute exacerbations of chronic obstructive pulmonary disease. N Engl J Med 1995 Sep 28 333 817-822.

• Original article (Subscription may be required)
• Medline abstract (Free)