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

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.