Noninvasive Ventilation and Outcomes Among Immunocompromised Patients: Noninvasive Ventilation and Outcomes Among Immunocompromised Patients

• Autores: Jean-Pierre Frat, Rémi Coudroy, Arnaud W Thille, Elie Azoulay, Djamel Mokart, Virginie Lemiale
• Localización: JAMA: the journal of the American Medical Association, ISSN 0098-7484, Vol. 315, Nº. 17, 2016, págs. 1901-1902
• Idioma: inglés
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• Resumen
  • English

    The use of noninvasive ventilation as first-line therapy for immunocompromised patients with acute respiratory failure remains controversial.1,2 Dr Lemiale and colleagues3 reported the largest randomized clinical trial to date (374 immunocompromised patients) with the aim of assessing whether noninvasive ventilation could improve outcomes. No difference was found between patients treated with oxygen therapy alone or with noninvasive ventilation.

  • English

    Dr Lemiale and colleagues1 found that early noninvasive ventilation compared with oxygen therapy alone did not reduce intubation rate and 28-day mortality in immunosuppressed patients with hypoxemic acute respiratory failure. The study has important limitations that the authors acknowledged only in part. There are at least 3 major methodological limitations in addition to the 2 already recognized by the authors (ie, the lower-than-expected mortality rate, making the study likely underpowered, and the significantly higher proportion of patients receiving high-flow nasal oxygen in the control group, limiting the ability to detect the potential benefit of noninvasive ventilation).