Observational case-control study of non-invasive ventilation in patients with ARDS

Monaldi Arch Chest Dis. 2008 Mar;69(1):5-10. doi: 10.4081/monaldi.2008.405.


Background: The application of non-invasive pressure support ventilation (NIPSV) in patients with acute lung injury or ARDS remains controversial despite recent promising results. Data in rather homogeneous ARDS groups is lacking.

Objective: To compare the outcome of NIPSV-treated patients satisfying the diagnostic criteria for primary (pulmonary) ARDS (ARDSp) and presenting without distant organ failures at admission, with those of a matched control group treated in the same ICU with endotracheal mechanical ventilation (ETMV).

Methods: We applied NIPSV in 12 immunocompetent and collaborative patients who met the above cited criteria. NIPSV failure rate, short-term oxygenation, length of stay, mortality rate and complications were analyzed and compared with a control group of 12 intubated ARDSp-patients matched for age, SAPS II, PaO2/FiO2 and pH at admission.

Results: NIPSV failed in 4 patients developing distant organ failures. Compared to the ETMV control group, NIPSV success patients had reduced cumulative time on ventilation (p = 0.001) and length of ICU stay (p = 0.004). After the first 60' of ventilation, oxygenation improved more in the NIPSV than in the ETMV group (146 +/- 52 mmHg vs 109 +/- 34 mmHg; p = 0.05). The overall ICU mortality rate did not differ significantly between the groups but tended to be higher in the NIPSV group.

Conclusions: In ARDSp patients without distant organ failures at admission and during the disease course, NIPSV might be a suitable alternative to invasive ventilation; however, the real effects on outcome of NIPSV applied to stable homogeneous subgroups of ARDS patients merit further investigations in randomised studies.

MeSH terms

  • Aged
  • Case-Control Studies
  • Cohort Studies
  • Critical Care*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Respiration, Artificial / methods*
  • Respiratory Distress Syndrome / etiology
  • Respiratory Distress Syndrome / therapy*
  • Treatment Outcome