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Early use of noninvasive positive pressure ventilation for acute lung injury: A multicenter randomized controlled trial*

Zhan, Qingyuan MD; Sun, Bing MD; Liang, Lirong MD; Yan, Xixin MD; Zhang, Lutao MD; Yang, Jingping MD; Wang, Ling MD; Ma, Zhuang MD; Shi, Liang MD; Wei, Luqing MD; Li, Guoqiang MD; Yang, Lan MD; Shi, Zhihong MD; Chen, Yuqing MD; Xu, Qixia MD; Li, Wei MD; Zhu, Xi MD; Wang, Zongyu MD; Sun, Yongchang MD; Zhuo, Jie MD; Liu, Yang MD; Li, Xuesong MD; Wang, Chen MD

doi: 10.1097/CCM.0b013e318232d75e
Clinical Investigations

Objective: Noninvasive positive pressure ventilation is beneficial for patients with acute respiratory failure. However, its possible benefit for patients with acute lung injury (200 mm Hg < PaO2/FIO2 ≤300 mm Hg) remains unclear. Our aim was to assess the safety and efficacy of noninvasive positive pressure ventilation for patients with acute lung injury and compare this with high-concentration oxygen therapy.

Design: A multicentered randomized controlled trial.

Setting: Ten multipurpose intensive care units.

Patients: Forty patients who fulfilled the criteria for acute lung injury were included in this study.

Interventions: Patients were randomly allocated to receive either noninvasive positive pressure ventilation (noninvasive positive pressure ventilation group) or high-concentration oxygen therapy through a Venturi mask (control group).

Measurements and Main Results: Twenty-one patients were assigned to the noninvasive positive pressure ventilation group and 19 were in the control group. At study entry, the patients' characteristics in the two groups were similar. Noninvasive positive pressure ventilation application decreased the respiratory rate and improved PaO2/FIO2 with time. The proportion of patients requiring intubation and the actual number of intubations in the noninvasive positive pressure ventilation group were significantly less than in the control group (one of 21 vs. seven of 19; p = .02, and one of 21 vs. four of 19; p = .04, respectively). Noninvasive positive pressure ventilation showed a trend for reducing inhospital mortality (one of 21 vs. five of 19; p = .09). The total number of organ failures in the noninvasive positive pressure ventilation group was significantly lower than in the control group (three vs. 14; p < .001).

Conclusions: Noninvasive positive pressure ventilation is safe for selected patients with acute lung injury. However, a larger randomized trial with need for intubation and mortality as the outcomes of interest is required.

From the Collaborative Research Group of Noninvasive Mechanical Ventilation for ALI/ARDS, including the following members: Department of Respiratory and Critical Care Medicine (QZ, BS, LL), Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University; the Pulmonary Department (XY, LZ), The Second Hospital Affiliated Hebei Medical University; the Department of Pulmonary and Critical Care Medicine (JY, LW), The Third Affiliated Hospital of Inner Mongolia Medical College; the Pulmonary Department (ZM, LS), The Shenyang Military Region General Hospital; the Pulmonary Department (LW, GL), The People's Armed Police Corps General Hospital of Tianjin; the Pulmonary Department (LY, ZS), The First Affiliated Hospital of Medical College, Xian Jiaotong University; the Pulmonary Department (YC, QX, WL), The Affiliated Hospital of Bengbu Medical College; the Department of Critical Care Medicine (XZ, ZW), The Third Hospital of Peking University; the Pulmonary Department (YS, JZ), Beijing Tongren Hospital; Department of Critical Care Medicine (YL, XL), Hebei Tangshan Gongren Hospital; and the Beijing Institute of Respiratory Medicine (CW), Beijing Hospital, Ministry of Health, Beijing, China.

* See also p. 669.

This study is supported by a grant from Beijing Municipal Science & Technology Commission Program (No. Y0905001040291).

This study was performed in the ICUs of the institutions listed.

The authors have not disclosed any potential conflicts of interest.

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© 2012 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins