Early use of noninvasive positive pressure ventilation for acute lung injury: a multicenter randomized controlled trial.
OBJECTIVE
Noninvasive positive pressure ventilation is beneficial for patients with acute respiratory failure. However, its possible benefit for patients with acute lung injury (200 mm Hg < PaO(2)/FIO(2) ≤300 mm Hg) remains unclear. Our aim was to assess the safety and efficacy of noninvasive positive pressure ventilation for patients with acute lung injury and compare this with high-concentration oxygen therapy.


METHODS
A multicentered randomized controlled trial.


METHODS
Ten multipurpose intensive care units.


METHODS
Forty patients who fulfilled the criteria for acute lung injury were included in this study.


METHODS
Patients were randomly allocated to receive either noninvasive positive pressure ventilation (noninvasive positive pressure ventilation group) or high-concentration oxygen therapy through a Venturi mask (control group).


RESULTS
Twenty-one patients were assigned to the noninvasive positive pressure ventilation group and 19 were in the control group. At study entry, the patients' characteristics in the two groups were similar. Noninvasive positive pressure ventilation application decreased the respiratory rate and improved PaO(2)/FIO(2) with time. The proportion of patients requiring intubation and the actual number of intubations in the noninvasive positive pressure ventilation group were significantly less than in the control group (one of 21 vs. seven of 19; p = .02, and one of 21 vs. four of 19; p = .04, respectively). Noninvasive positive pressure ventilation showed a trend for reducing inhospital mortality (one of 21 vs. five of 19; p = .09). The total number of organ failures in the noninvasive positive pressure ventilation group was significantly lower than in the control group (three vs. 14; p < .001).


CONCLUSIONS
Noninvasive positive pressure ventilation is safe for selected patients with acute lung injury. However, a larger randomized trial with need for intubation and mortality as the outcomes of interest is required.
Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
Qingyuan
Q
Zhan
Bing
B
Sun
Lirong
L
Liang
Xixin
X
Yan
Lutao
L
Zhang
Jingping
J
Yang
Ling
L
Wang
Zhuang
Z
Ma
Liang
L
Shi
Luqing
L
Wei
Guoqiang
G
Li
Lan
L
Yang
Zhihong
Z
Shi
Yuqing
Y
Chen
Qixia
Q
Xu
Wei
W
Li
Xi
X
Zhu
Zongyu
Z
Wang
Yongchang
Y
Sun
Jie
J
Zhuo
Yang
Y
Liu
Xuesong
X
Li
Chen
C
Wang
D055371:Acute Lung Injury / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D000328:Adult; D001784:Blood Gas Analysis; D002681:China; D003422:Critical Care / Q000379:methods; D016638:Critical Illness / Q000401:mortality / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007442:Intubation, Intratracheal; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption / Q000502:physiology; D061214:Patient Safety; D011175:Positive-Pressure Respiration / Q000379:methods*; D011446:Prospective Studies; D011659:Pulmonary Gas Exchange; D012016:Reference Values; D012128:Respiratory Distress Syndrome / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D012129:Respiratory Function Tests; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome