Noninvasive ventilation for treating acute respiratory failure in AIDS patients with Pneumocystis carinii pneumonia.

OBJECTIVE

To compare noninvasive positive pressure ventilation (NPPV) vs. invasive mechanical ventilation in AIDS patients with Pneumocystis carinii pneumonia (PCP)-related acute respiratory failure (ARF).

DESIGN

A single-center, prospective, case-control trial.

SETTING

An ICU of a private tertiary hospital specialized in infectious disease.

PATIENTS: Forty-eight AIDS patients with severe PCP-related ARF needing mechanical ventilation.

INTERVENTIONS: Twenty-four patients treated with NPPV by a facial mask strictly matched with 24 patients treated with invasive ventilation by endotracheal intubation.

RESULTS

Use of NPPV avoided intubation in 67% of patients, and avoidance of intubation was associated with improved survival (100% vs. 38%; P=0.003). NPPV-treated patients required fewer invasive devices ( P<0.001) and had a lower incidence of pneumothoraces (8.3% vs. 37.5%; P=0.039). The NPPV-treated group required a nurse workload similar to that of the conventional ventilation group, but this group had a shorter duration of stay in the ICU ( P=0.013). The NPPV-treated group had a lower mortality in the ICU, the hospital and within 2 months of study entry. Differences in mortality between the two groups disappeared after 6 months.

CONCLUSIONS

The findings of this study seem to provide further support for applying NPPV in AIDS patients with severe PCP-related ARF as a first-line therapeutic choice, but randomized controlled trials are required to confirm our results.