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.