Wondering about the outcomes of those for those whom intubation was indicated but refused vs those who accepted intubation. Can't seem to find a good article, please help.
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Honrubia et al: Noninvasive vs Conventional Mechanical Ventilation in Acute Respiratory Failure A Multicenter, Randomized Controlled Trial. CHEST 2005; 128:39163924
"Avoidance of intubation, mortality, and consumption of resources were
the outcome variables. Thirty-one patients were assigned to the noninvasive group, and 33 were assigned to the conventional group. In the noninvasive group, 58% patients were intubated, vs 100% in the conventional group (relative risk reduction, 43%; p < 0.001). Stratification by type
of ARF gave similar results. In the ICU, death occurred in 23% and 39% (p 0.09) and complications occurred in 52% and 70% (p 0.07) in the noninvasive and conventional groups, respectively. There were no differences in length of stay."
Wood et al: The Use of Noninvasive Positive Pressure Ventilation in the Emergency Department: Results of a Randomized Clinical Trial. CHEST 1999; 113: 1339-1346.
The primary outcome measure was the need for tracheal intubation and
mechanical ventilation. Secondary outcomes also assessed included hospital mortality, hospital length of stay, acquired organ system derangements, and the utilization of respiratory care personnel. Sixteen patients (59.3%) were randomly assigned to receive conventional medical therapy plus NPPV,
and 11 patients (40.7%) were randomly assigned to receive conventional medical therapy without NPPV. The two groups were similar at the time of randomization in the ED with regard to demographic characteristics, hospital admission diagnoses, and severity of illness. Tracheal intubation and mechanical ventilation was required in seven patients (43.8%) receiving conventional medical therapy plus NPPV and in five patients (45.5%) receiving conventional medical therapy alone (relative risk 50.96; 95% confidence interval50.41 to 2.26; p50.930). There was a trend towards a
greater hospital mortality rate among patients in the NPPV group (25%) compared to patients in the conventional medical therapy group (0.0%) (p50.123). Among patients who subsequently required mechanical ventilation, those in the NPPV group had a longer time interval from ED arrival to the
start of mechanical ventilation compared to patients in the conventional medical therapy group (26.0627.0 h vs 4.866.9 h; p50.055).
Lightowler JV, Jadwiga AW, Wedzicha A, Elliot MW, Ram FS. Non-invasive positive pressure ventilation to treat respiratory failure resulting from exacerbations of chronic obstructive pulmonary disease: Cochrane systematic review and meta-analysis. BMJ. 2003; 326:185
"NPPV should be the first line intervention in addition to usual medical care to manage respiratory failure secondary to an acute exacerbation of chronic obstructive pulmonary disease in all suitable patients. NPPV should be tried early in the course of respiratory failure and before severe acidosis, to reduce mortality, avoid endotracheal intubation, and decrease treatment failure.