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).

DESIGN:

A single-center, prospective, case-control trial.

SETTING:

An ICU of a private tertiary hospital specialized in infectious disease.

PATIENTS:

Forty-eight AIDS patients with severe PCP-related ARF needing mechanical ventilation.

INTERVENTIONS:

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: Marco Confalonieri, Edo Calderini, Susanna Terraciano, Giovanna Chidini, Enza Celeste, Giacomo Puccio, Cesare Gregoretti, G Umberto Meduri
• Journal: Intensive care medicine (Intensive Care Med) Vol. 28 Issue 9 Pg. 1233-8 (Sep 2002) ISSN: 0342-4642 [Print] United States
• PMID: 12209270 (Publication Type: Clinical Trial, Controlled Clinical Trial, Journal Article)

Topics

• AIDS-Related Opportunistic Infections (complications, physiopathology, therapy)
• Acute Disease
• Adult
• Case-Control Studies
• Humans
• Intubation, Intratracheal
• Middle Aged
• Pneumonia, Pneumocystis (complications, physiopathology, therapy)
• Prospective Studies
• Respiration, Artificial (methods)
• Respiratory Insufficiency (etiology, physiopathology, therapy)
• Survival Analysis
• Treatment Outcome