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Noninvasive ventilation (NIV) in patients with acute respiratory failure (ARF), which was originally described decades ago, underwent a rebirth after reports of successful use in 1989. Over the following 18 years the literature on NIV has grown substantially. This paper summarizes the randomized controlled trials (RCTs) on NIV for acute respiratory failure. We conducted an extensive literature search and selected RCTs from that search. The results are presented primarily by etiology of respiratory failure, but we also include a short section on NIV for ARF in immunocompromised patients. The latter studies included patients with various etiologies of respiratory failure but with the common comorbidity of immunocompromise. Most of the RCTs have studied NIV for exacerbation of chronic obstructive pulmonary disease (COPD) or cardiogenic pulmonary edema. In general the RCTs have been small and used endotracheal intubation or NIV failure rate as primary outcomes. We conclude that NIV for ARF is supported by strong evidence from patients with COPD, but there is only weak support for NIV in other patient groups, such as immunocompromised patients. For other groups, such as patients with asthma, pneumonia, or acute lung injury, RCT-level evidence is lacking or does not suggest benefit. Clearly, major gaps remain in our evidence base.
- noninvasive ventilation
- acute respiratory failure
- chronic obstructive pulmonary disease
- cardiogenic pulmonary edema
- acute lung injury
- acute respiratory distress syndrome
- Correspondence: Sean P Keenan MD FRCPC MSc, Intensive Care Unit, Royal Columbian Hospital, 330 East Columbia Street, New Westminster, British Columbia, Canada V3L 3W9. E-mail: .
Dr Keenan has had a relationship with Respironics. The authors report no other conflicts of interest related to the content of this paper.
Dr Keenan presented a version of this paper at the 42nd Respiratory Care Journal Conference, “Noninvasive Ventilation in Acute Care: Controversies and Emerging Concepts,” held March 7-9, 2008, in Cancún, México.
- Copyright © 2009 by Daedalus Enterprises Inc.