title: Noninvasive ventilation for treating acute respiratory failure in AIDS patients with Pneumocystis carinii pneumonia.
abstract: OBJECTIVE
  To compare noninvasive positive pressure ventilation (NPPV) vs. invasive mechanical ventilation in AIDS patients with Pneumocystis carinii pneumonia (PCP)-related acute respiratory failure (ARF).
  
  
  METHODS
  A single-center, prospective, case-control trial.
  
  
  METHODS
  An ICU of a private tertiary hospital specialized in infectious disease.
  
  
  METHODS
  Forty-eight AIDS patients with severe PCP-related ARF needing mechanical ventilation.
  
  
  METHODS
  Twenty-four patients treated with NPPV by a facial mask strictly matched with 24 patients treated with invasive ventilation by endotracheal intubation.
  
  
  RESULTS
  Use of NPPV avoided intubation in 67% of patients, and avoidance of intubation was associated with improved survival (100% vs. 38%; P=0.003). NPPV-treated patients required fewer invasive devices ( P<0.001) and had a lower incidence of pneumothoraces (8.3% vs. 37.5%; P=0.039). The NPPV-treated group required a nurse workload similar to that of the conventional ventilation group, but this group had a shorter duration of stay in the ICU ( P=0.013). The NPPV-treated group had a lower mortality in the ICU, the hospital and within 2 months of study entry. Differences in mortality between the two groups disappeared after 6 months.
  
  
  CONCLUSIONS
  The findings of this study seem to provide further support for applying NPPV in AIDS patients with severe PCP-related ARF as a first-line therapeutic choice, but randomized controlled trials are required to confirm our results.
authors.affiliation: Struttura Complessa Pneumologia, Azienda Ospedaliera di Trieste, U.O. Pneumologia, via Bonomea 265, 34100 Trieste, Italy. mconfalonieri@qubisoft.it
authors.forename: Marco
authors.initials: M
authors.lastname: Confalonieri
authors.forename: Edo
authors.initials: E
authors.lastname: Calderini
authors.forename: Susanna
authors.initials: S
authors.lastname: Terraciano
authors.forename: Giovanna
authors.initials: G
authors.lastname: Chidini
authors.forename: Enza
authors.initials: E
authors.lastname: Celeste
authors.forename: Giacomo
authors.initials: G
authors.lastname: Puccio
authors.forename: Cesare
authors.initials: C
authors.lastname: Gregoretti
authors.forename: G Umberto
authors.initials: GU
authors.lastname: Meduri
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D000208:Acute Disease; D000328:Adult; D016022:Case-Control Studies; D006801:Humans; D007442:Intubation, Intratracheal; D008875:Middle Aged; D011020:Pneumonia, Pneumocystis / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000379:methods*; D012131:Respiratory Insufficiency / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D016019:Survival Analysis; D016896:Treatment Outcome