Noninvasive Ventilatory Support

In COPD

Brochard L, Mancebo J, Wysocki M, et al. Noninvasive ventilation for acute exacerbations of COPD. New Engl J Med 1995; 333:817-22. Landmark prospective, randomized study found use of NIPPV in selected patients with COPD exacerbations resulted in fewer intubations, complications, days in hospital, and lower in-hospital mortality compared to standard treatment. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=7651472

Nava S, Ambrosino N, Clini E, et al. Non-invasive mechanical ventilation in the weaning of patients with respiratory failure due to chronic obstructive pulmonary disease. Ann Intern Med 1998;128:721-8. Oft-cited RCT included 50 patients intubated for a COPD exacerbation who failed a T-piece trial.  Patients randomized to immediate extubation to NIPPV had decreased duration of mechanical ventilation and improved survival compared to the control group undergoing PS wean with twice daily spontaneous breathing trials. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9556465

In hypoxemic respiratory failure (all types):

Declaux C, L'Her E, Alberti C, et al. Treatment of acute hypoxemic nonhypercapnic respiratory insufficiency with CPAP delivered by facemask. JAMA 2000;284:2352-60. Prospective, randomized, multicenter study compared oxygen to oxygen plus CPAP in this population (123 patients; 17% cardiac etiology, 83% ALI). Study found no difference in the need for intubation, length of hospital stay, or hospital mortality, and the CPAP group had an increased incidence of adverse events. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11066186

Antonelli M, Conti G, Rocco M, et al. A comparison on NIPPV and conventional mechanical ventilation in patients with acute respiratory failure. New Engl J Med 1998; 339:429-35. Randomized study compared NIPPV with immediate intubation and conventional ventilation in 64 patients with acute, non-hypercapnic, hypoxemic respiratory failure (19% cardiogenic and 25% ARDS).  Use of NIPPV resulted in gas exchange and survival comparable to conventional ventilation but was associated with fewer serious complications and shorter ICU stays. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=9700176

Ferrer M, Esquinas A, Leon M, et al. Non-invasive ventilation in severe hypoxemic respiratory failure: a randomized clinical trial. Am J Respir Crit Care Med 2003;168:1140-4. Study of 105 non-hypercapnic patients found NIPPV decreased need for intubation and improved 90-day survival compared to oxygen therapy alone.  Unlike some prior studies, subgroup analysis found the 34 patients with pneumonia had the greatest benefit while mask ventilation did not appear to reduce the need for intubation in patients with ARDS and cardiogenic edema. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14500259

In cardiogenic hypoxemic respiratory failure:

Bersten AD, Holt AW, Vedig AE, et al. Treatment of severe cardiogenic pulmonary edema with CPAP delivered by facemask. New Engl J Med 1991;325:1825-30. Randomized study of 39 patients with hypercapnic cardiogenic respiratory failure found use of CPAP plus oxygen resulted in better gas exchange in the first 24 hours and less need for intubation than use of oxygen alone. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=1961221

Masip J, Betbese AJ, Paez J, et al. Non-invasive pressure support ventilation versus conventional oxygen therapy in acute cardiogenic pulmonary edema: a randomized trial.  Lancet 2000; 356:2126-32. Study of 37 patients (of whom 43% had hypercapnia) found pressure support by mask reduced the need for intubation (5% vs. 33%).  There was no difference in duration of hospital stay or mortality. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11191538

Nava S, Carbone G, DiBattista, N, et al. Non-invasive ventilation in cardiogenic pulmonary edema: a multicenter randomized trial.  Am J Respir Crit Care Med 2003; 168:1432-7.  This larger study (130 patients) found non-invasive pressure support did not improve outcomes compared to conventional therapy.  Mask ventilation reduced intubations in the 64 patients with PaCO2 > 45 mmHg (6% vs. 29%), but this difference was not significant after regression analysis. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12958051

Following extubation

Ferrer M, Valencia M, Nicolas JM, et al.  Early noninvasive ventilation averts extubation failure in patients at risk: a randomized trial.  Am J Respir Crit Care Med. 2006; 173:164-70. This RCT enrolled 162 mechanically ventilated patients who tolerated a spontaneous breathing trial after recovery from the acute episode but had increased risk for respiratory failure after extubation. Early use of noninvasive ventilation averted respiratory failure after extubation and decreased intensive care unit mortality among patients at increased risk. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16224108&query_hl=12&itool=pubmed_DocSum  
Esteban A, Frutos-Vivar F, Ferguson ND, et al. Noninvasive positive-pressure ventilation for respiratory failure after extubation. New Engl J Med 2004; 350:2452-60. This trial of 221 patients with respiratory failure within 48 hours of being extubated after receiving at least 48 hours of mechanical ventilation randomized patients to noninvasive ventilation by face mask or standard medical therapy.  Noninvasive ventilation did not reduce the need for re-intubation and the standard-therapy group had lower ICU mortality (14% vs. 25% in noninvasive group).  These results suggest noninvasive positive-pressure ventilation should not be used in unselected patients failing extubation. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15190137&query_hl=33&itool=pubmed_docsum

In neuromuscular weakness

Perrin C, Unterborn JN, Ambrosio CD et al. Pulmonary complications of chronicneuromuscular diseases and their management. Muscle Nerve 2004;29:5-27 Concise review including use of non-invasive ventilation and general management of this subset of patients including sleep disordered breathing. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14694494

Bourke SC, Tomlinson M, Williams TL, et al. Effects of non-invasive ventilation on survival and quality of life in patients with amyotrophic lateral sclerosis: a randomised controlled trial. Lancet Neurol  2006; 5:140-7. This study of 41 patients found NIV improved survival by a median of 205 days (p < .01) in patients with normal or moderately impaired bulbar function.  All patients had at least some degree of improved quality of life with NIV, but those with poor bulbar function did not have improved survival. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16426990&query_hl=32&itool=pubmed_docsum