Cited by 1,014Respiratory Support and MechanismsAirway Management and Intubation TechniquesObstructive Sleep Apnea Research

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A Comparison of Noninvasive Positive-Pressure Ventilation and Conventional Mechanical Ventilation in Patients with Acute Respiratory Failure

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Antonelli, Massimo, Conti, Giorgio, Rocco, Monica, Bufi, Maurizio, De Blasi, Roberto Alberto, Vivino, Gabriella, Gasparetto, Alessandro, Meduri, Gianfranco Umberto·1998·New England Journal of Medicine

DOI 10.1056/nejm199808133390703

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Abstract

BACKGROUND AND METHODS: The role of noninvasive positive-pressure ventilation delivered through a face mask in patients with acute respiratory failure is uncertain. We conducted a prospective, randomized trial of noninvasive positive-pressure ventilation as compared with endotracheal intubation with conventional mechanical ventilation in 64 patients with hypoxemic acute respiratory failure who required mechanical ventilation. RESULTS: Within the first hour of ventilation, 20 of 32 patients (62 percent) in the noninvasive-ventilation group and 15 of 32 (47 percent) in the conventional-ventilation group had an improved ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen (PaO2:FiO2) (P=0.21). Ten patients in the noninvasive-ventilation group subsequently required endotracheal intubation. Seventeen patients in the conventional-ventilation group (53 percent) and 23 in the noninvasive-ventilation group (72 percent) survived their stay in the intensive care unit (odds ratio, 0.4; 95 percent confidence interval, 0.1 to 1.4; P=0.19); 16 patients in the conventional-ventilation group and 22 patients in the noninvasive-ventilation group were discharged from the hospital. More patients in the conventional-ventilation group had serious complications (66 percent vs. 38 percent, P=0.02) and had pneumonia or sinusitis related to the endotracheal tube (31 percent vs. 3 percent, P=0.003). Among the survivors, patients in the noninvasive-ventilation group had shorter periods of ventilation (P=0.006) and shorter stays in the intensive care unit (P=0.002). CONCLUSIONS: In patients with acute respiratory failure, noninvasive ventilation was as effective as conventional ventilation in improving gas exchange and was associated with fewer serious complications and shorter stays in the intensive care unit.

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Authors: Antonelli, M., Conti, G., Rocco, M., Bufi, M., De Blasi, R. A., Vivino, G., Gasparetto, A., & Meduri, G. U.
Affiliations: Policlinico Umberto I (IT)
University of Tennessee Health Science Center (US)
ORCID: Antonelli, Massimo
Conti, Giorgio
Rocco, Monica
Gasparetto, Alessandro
Meduri, Gianfranco Umberto
Venue: New England Journal of Medicine
Publisher: Massachusetts Medical Society
Published: 1998-08-13
Volume: 339
Issue: 7
Pages: 429-435
ISSN: 0028-4793 (ISSN-L)
1533-4406
DOI: 10.1056/nejm199808133390703
OpenAlex: W2331306740
Cited by: 1,014
References: 27
Citations by year: 2026: 7 · 2025: 14 · 2024: 15 · 2023: 19 · 2022: 38 · 2021: 29 · 2020: 28 · 2019: 25 · 2018: 32 · 2017: 35 · 2016: 32 · 2015: 38 · 2014: 27 · 2013: 32 · 2012: 24
FWCI: 50.68
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: New England Journal of Medicine (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
Health Sciences › Medicine › Anesthesiology and Pain Medicine › Airway Management and Intubation Techniques
Health Sciences › Medicine › Physiology (medical) › Obstructive Sleep Apnea Research
Keywords: noninvasive positive pressure ventilation, acute respiratory failure, hypoxemic respiratory failure, endotracheal intubation, mechanical ventilation, PaO2/FiO2 ratio, ventilator-associated pneumonia, ICU length of stay, ventilator complications, mask ventilation
MeSH terms: Acute Disease, Aged, Female, Humans, Intensive Care Units, Intubation, Intratracheal, Length of Stay, Male, Masks, Middle Aged, Oxygen, Positive-Pressure Respiration, Prospective Studies, Pulmonary Gas Exchange, Respiration, Artificial, Respiratory Insufficiency

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A Comparison of Noninvasive Positive-Pressure Ventilation and Conventional Mechanical Ventilation in Patients with Acute Respiratory Failure

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