A multicenter RCT of noninvasive ventilation in pneumonia-induced early mild acute respiratory distress syndrome

作者：for the ENIVA Study Group, Hangyong He, Bing Sun, Lirong Liang, Yanming Li, He Wang, Luqing Wei, Guofeng Li, Shuliang Guo, Jun Duan, Yuping Li, Ying Zhou, Yusheng Chen, Hongru Li, Jingping Yang, Xiyuan Xu, Liqiang Song, Jie Chen, Yong Bao, Feng Chen, Ping Wang, Lixi Ji, Yongxiang Zhang, Yanyan Ding, Liangan Chen, Ying Wang, Lan Yang, Tian Yang, Heng Weng, Hongyan Li, Daoxin Wang, Jin Tong, Yongchang Sun, Ran Li, Faguang Jin, Chunmei Li, Bei He, Lina Sun, Changzheng Wang, 王长征, Mingdong Hu, Xiaohong Yang, Qin Luo, Jin Zhang, Hai Tan, Chen Wang, Chen Wang · 发表于：Critical Care · 年份：2019 · DOI：10.1186/s13054-019-2575-6 · 被引用次数：94 · 研究领域：Respiratory Support and Mechanisms、Nosocomial Infections in ICU、Sepsis Diagnosis and Treatment

Our pilot study suggested that noninvasive ventilation (NIV) reduced the need for intubation compared with conventional administration of oxygen on patients with “early” stage of mild acute respiratory distress syndrome (ARDS, PaO 2 /FIO 2 between 200 and 300). To evaluate whether early NIV can reduce the need for invasive ventilation in patients with pneumonia-induced early mild ARDS. Prospective, multicenter, randomized controlled trial (RCT) of NIV compared with conventional administration of oxygen through a Venturi mask. Primary outcome included the numbers of patients who met the intubation criteria. Two hundred subjects were randomized to NIV ( n = 102) or control ( n = 98) groups from 21 centers. Baseline characteristics were similar in the two groups. In the NIV group, PaO 2 /FIO 2 became significantly higher than in the control group at 2 h after randomization and remained stable for the first 72 h. NIV did not decrease the proportion of patients requiring intubation than in the control group (11/102 vs. 9/98, 10.8% vs. 9.2%, p = 0.706). The ICU mortality was similar in the two groups (7/102 vs. 7/98, 4.9% vs. 3.1%, p = 0.721). Multivariate analysis showed minute ventilation greater than 11 L/min at 48 h was the independent risk factor for NIV failure (OR, 1.176 [95% CI, 1.005–1.379], p = 0.043). Treatment with NIV did not reduce the need for intubation among patients with pneumonia-induced early mild ARDS, despite the improved PaO 2 /FIO 2 observed with NIV compare...