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Comparative Study
. 2024 Aug 24;69(9):1138-1145.
doi: 10.4187/respcare.11286.

Noninvasive Ventilation in Critically Ill Patients With Severe Acute Respiratory Infections

Ghaida Jabri  1   2   3 , Farah Alotaibi  4 , Amjad M Ahmed  1   5   2 , Jesna Jose  6   7 , Farhan Z Alenezi  1   2   3 , Musharaf Sadat  1   2   3 , Felwa Bin Humaid  1   2   3 , Fahad Al-Hameed  8   9   10 , Javed Memon  11 , Kasim Al Khatib  12 , Abdullah M Alsuayb  1   2   3 , Mohammed AlObaidi  1   2   3 , Mohammed Al Mutairi  1   2   3 , Ahmad A Alanaizi  1   2   3 , Fuad Alghamdi  1   2   3 , Yaseen M Arabi  13   2   3
Affiliations
Comparative Study

Noninvasive Ventilation in Critically Ill Patients With Severe Acute Respiratory Infections

Ghaida Jabri et al. Respir Care. .

Abstract

Background: The objective of this study was to evaluate the association between noninvasive ventilation (NIV) compared with invasive ventilation and mortality in subjects with severe acute respiratory infection.

Methods: This was a retrospective multi-center study of subjects with severe acute respiratory infection treated with ventilatory support between September 2012 and June 2018. We compared the 90-d mortality of subjects managed initially with NIV (NIV group) with those managed with invasive ventilation only (invasive ventilation group), adjusting by propensity score.

Results: Of 383 subjects, 189 (49%) were in the NIV group and 194 (51%) were in the invasive ventilation group. Of the subjects initially treated with NIV, 117 (62%) were eventually intubated. Crude 90-d mortality was lower in the NIV group versus the invasive ventilation group (42 [22.2%] vs 77 [39.7%]; P < .001). After propensity score adjustment, NIV was associated with lower 90-d mortality than invasive ventilation (odds ratio 0.54, 95% CI 0.38-0.76; P < .001). The association of NIV with mortality compared with invasive ventilation was not different across the studied subgroups.

Conclusions: In subjects with severe acute respiratory infection and acute respiratory failure, NIV was commonly used. NIV was associated with a lower 90-d mortality. The observed high failure rate suggests the need for further research to optimize patient selection and facilitate early recognition of NIV failure.

Keywords: Noninvasive ventilation; mechanical ventilation; respiratory failure; severe acute respiratory infection.

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Conflict of interest statement

The authors have disclosed no conflicts of interest.

Figures

Fig. 1.
Fig. 1.
A butterfly plot, showing propensity scores in subjects with severe acute respiratory infection who received noninvasive ventilation (NIV) and those who received invasive ventilation.
Fig. 2.
Fig. 2.
Kaplan-Meir curves for survival of subjects who received noninvasive ventilation (NIV) and those who received invasive ventilation. P value for the log-rank test is reported.
See this image and copyright information in PMC

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