Early noninvasive ventilation, compared with oxygen therapy alone, did not reduce 28-day all-cause mortality in critically ill immunocompromised patients with acute respiratory failure, based on a randomized, parallel-group study of 374 patients conducted in 28 ICUs in France and Belgium.
Overall, 46 of 191 patients (24%) in the noninvasive ventilation group died, compared with 50 of 183 (27%) in the oxygen-alone group. A similar number of patients from each group required intubation – 38% in the noninvasive ventilation group and 45% in the oxygen group – with similar time to intubation. Nearly 85% of the patients were receiving treatment for hematologic malignancies or solid tumors, researchers reported in a study published online Oct. 7 in JAMA.
No significant differences between groups were observed in requirement for intubation, ICU or hospital length of stay, or duration of invasive mechanical ventilation. The study found no evidence that noninvasive ventilation influenced mortality estimates or was beneficial to any subgroup based on hypoxemia severity or underlying condition.
The study was limited, however, by a lower than expected mortality rate with oxygen alone, and as a result was not powered to detect significant between-group differences. Based on earlier studies, the researchers assumed a 35% mortality rate in the oxygen-alone group, but the actual rate was 27% (JAMA. 2015 Oct 7. doi: 10.1001/jama.2015.12402).
“Therefore, there remains uncertainty regarding our null finding, which may nonetheless fail to exclude a clinically important effect,” wrote Dr. Virginie Lemiale of Saint-Louis University Hospital, Paris, and colleagues.
Furthermore, high-flow nasal oxygen was used in about 40% of all patients, which may have decreased requirements for intubation as well as mortality rates. High-flow nasal oxygen was used more often in the oxygen group (44%) than in the noninvasive ventilation group (31%) (P = .01).
Dr. Lemiale and coauthors reported having no disclosures.