Stephen J.LurieMD, PhD, Senior Editor
To the Editor: Dr Keenan and colleagues1 found that noninvasive ventilation (NIV) did not improve outcomes in patients who developed postextubation acute respiratory failure (ARF). This result was unexpected and conflicts with recent literature.
In a prospective observational study, for instance, NIV was found to avoid reintubation in 18 of 21 consecutive patients who developed ARF after bilateral lung transplantation, mainly for cystic fibrosis.2 Among those who responded to NIV, oxygenation and respiratory acidosis were improved, with a low rate of complications and no mortality in the intensive care unit (ICU). The first prospective randomized controlled study, in the ICU setting,3 demonstrated that NIV was safe and effective in reducing the need for reintubation and improving in-hospital and 3-month survival in 24 patients with hypoxemic ARF after lung resection compared with standard medical treatment. Furthermore, when correctly set, noninvasive ventilation can improve gas exchange, breathing pattern and decreases the work of breathing in patients with nonchronic respiratory failure (CRF) with persistent ARF after early extubation,4 as well as those with CRF who are not ready to sustain totally spontaneous breathing.5 These findings suggest that NIV may replace conventional mechanical ventilation in some circumstances.
Girault C, Auriant I. Differences in Success Rates of Noninvasive Ventilation. JAMA. 2002;288(20):2540. doi:10.1001/jama.288.20.2540-JLT1127-2-1