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

Intensive Care Med. 2002 Sep;28(9):1233-8. doi: 10.1007/s00134-002-1395-2. Epub 2002 Jul 6.


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.

Publication types

  • Clinical Trial
  • Controlled Clinical Trial

MeSH terms

  • AIDS-Related Opportunistic Infections / complications
  • AIDS-Related Opportunistic Infections / physiopathology
  • AIDS-Related Opportunistic Infections / therapy*
  • Acute Disease
  • Adult
  • Case-Control Studies
  • Humans
  • Intubation, Intratracheal
  • Middle Aged
  • Pneumonia, Pneumocystis / complications
  • Pneumonia, Pneumocystis / physiopathology
  • Pneumonia, Pneumocystis / therapy*
  • Prospective Studies
  • Respiration, Artificial / methods*
  • Respiratory Insufficiency / etiology
  • Respiratory Insufficiency / physiopathology
  • Respiratory Insufficiency / therapy*
  • Survival Analysis
  • Treatment Outcome