To the Editor Dr Lemiale and colleagues1 found that early noninvasive ventilation compared with oxygen therapy alone did not reduce intubation rate and 28-day mortality in immunosuppressed patients with hypoxemic acute respiratory failure. The study has important limitations that the authors acknowledged only in part.
There are at least 3 major methodological limitations in addition to the 2 already recognized by the authors (ie, the lower-than-expected mortality rate, making the study likely underpowered, and the significantly higher proportion of patients receiving high-flow nasal oxygen in the control group, limiting the ability to detect the potential benefit of noninvasive ventilation).2
Navalesi P, Gregoretti C, Antonelli M. Noninvasive Ventilation and Outcomes Among Immunocompromised Patients. JAMA. 2016;315(17):1902. doi:10.1001/jama.2016.0677