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Antonelli M, Conti G, Bufi M, et al. Noninvasive Ventilation for Treatment of Acute Respiratory Failure in Patients Undergoing Solid Organ Transplantation: A Randomized Trial. JAMA. 2000;283(2):235–241. doi:10.1001/jama.283.2.235
Author Affiliations: Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore Rome, Italy (Drs Antonelli and Conti), Università La Sapienza Policlinico Umberto I, Rome (Drs Bufi, Costa, Lappa, Rocco, and Gasparetto); and the Department of Medicine, Pulmonary and Critical Care Division, Memphis Lung Research Program, University of Tennessee, Memphis (Dr Meduri).
Caring for the Critically Ill Patient Section Editor:Deborah J. Cook, MD, Consulting Editor, JAMA.
Advisory Board: David Bihari, MD; Christian Brun-Buisson, MD; Timothy Evans,
MD; John Heffner, MD; Norman Paradis, MD.
Context Noninvasive ventilation (NIV) has been associated with lower rates of
endotracheal intubation in populations of patients with acute respiratory
Objective To compare NIV with standard treatment using supplemental oxygen administration
to avoid endotracheal intubation in recipients of solid organ transplantation
with acute hypoxemic respiratory failure.
Design and Setting Prospective randomized study conducted at a 14-bed, general intensive
care unit of a university hospital.
Patients Of 238 patients who underwent solid organ transplantation from December
1995 to October 1997, 51 were treated for acute respiratory failure. Of these,
40 were eligible and 20 were randomized to each group.
Intervention Noninvasive ventilation vs standard treatment with supplemental oxygen
Main Outcome Measures The need for endotracheal intubation and mechanical ventilation at any
time during the study, complications not present on admission, duration of
ventilatory assistance, length of hospital stay, and intensive care unit mortality.
Results The 2 groups were similar at study entry. Within the first hour of treatment,
14 patients (70%) in the NIV group, and 5 patients (25%) in the standard treatment
group improved their ratio of the PaO2 to the fraction of inspired
oxygen (FIO2). Over time, a sustained improvement in PaO2 to FIO2 was noted in 12 patients (60%) in the NIV group,
and in 5 patients (25%) randomized to standard treatment (P = .03). The use of NIV was associated with a significant reduction
in the rate of endotracheal intubation (20% vs 70%; P
= .002), rate of fatal complications (20% vs 50%; P
= .05), length of stay in the intensive care unit by survivors (mean [SD]
days, 5.5  vs 9 ; P = .03), and intensive care
unit mortality (20% vs 50%; P = .05). Hospital mortality
did not differ.
Conclusions These results indicate that transplantation programs should consider
NIV in the treatment of selected recipients of transplantation with acute
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