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Noninvasive Ventilation Resulted in Better Outcomes Compared with Conventional Mechanical Ventilation In Patients with Chronic Obstructive Pulmonary Disease and Pulmonary Edema
Journal of the American Medical Association (JAMA)
12/11/2003
By Joene Hendry
Patients admitted to the intensive care unit for acute exacerbation of chronic obstructive pulmonary disease (COPD) or severe cardiogenic pulmonary oedema (CPE) had fewer nosocomial infections and better outcomes when ventilatory support initially consisted of noninvasive ventilation compared with conventional mechanical ventilation.
Over an 8-year period at Henri Mondor University hospital in Cretiel, France, of the 8,206 patients admitted to the intensive care unit (ICU), 470 received either noninvasive ventilation or conventional mechanical ventilation for exacerbation of COPD or CPE. "No change over the 8 years occurred in the therapeutic management of these patients except for the use of NIV [noninvasive ventilation]," writes Emmanuelle Girou, PharmD, and colleagues.
During the study period, the use of noninvasive ventilation increased in the study patients receiving ventilatory support (P < .001) and, at the same time, the crude ICU mortality rate among this group of patients decreased from 21% in 1994 to 7% in 2001 (P = .04).
Overall, 65% of the patients received noninvasive ventilation. Of these, 11% eventually required endotracheal intubation and conventional mechanical ventilation. Among the 35 cases of noninvasive ventilation failure, 17 patients developed ICU-acquired pneumonia.
In adjusted covariate and propensity score analyses, noninvasive ventilation was independently linked with reduced risk of death (odds ratio 0.37). In contrast, a high Simplified Acute Physiology Score II on admission had an odds ratio for ICU mortality of 1.05, while an ICU-acquired infection had an odds ratio for mortality of 3.08.
The authors conclude that a progressively increased use of noninvasive ventilation in this patient population "was associated with a sustained reduction in mortality over the years in the ICU, which may be explained by a reduced rate of complications usually associated with conventional mechanical ventilation, including nosocomial infections."
JAMA 2003;290:2985-2991.
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