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Noninvasive Positive-Pressure Ventilation for Acute Respiratory Failure: Comparative Effectiveness

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NPPV Versus Supportive Medical Therapy in Patients With Acute Respiratory Failure (2 of 2)

There was moderate-strength evidence that hospital-acquired pneumonia decreased with noninvasive positive-pressure ventilation (NPPV) versus supportive care. Nine studies assessed the effects of NPPV versus supportive care on hospital-acquired pneumonia. Rates of hospital-acquired pneumonia ranged from 0–10 percent for NPPV and from 7–24 percent for supportive care. Hospital-acquired pneumonia is defined as pneumonia that develops more than 48 hours after hospitalization but was not incubating at the time of admission. Overall, there was a lower risk of pneumonia when NPPV was employed versus usual supportive care (odds ratio [OR] = 0.27; 95-percent confidence interval [95% CI], 0.15-0.49). There was no significant variability in treatment effects across studies.

No difference in myocardial infarction rates was observed with NPPV versus supportive care. The strength of evidence for this finding was rated moderate. Seven studies reported on the effects of NPPV versus supportive care on myocardial infarction rates; six of the studies were rated good in quality. Rates of myocardial infarction ranged from 2–30 percent for NPPV and from 0–30 percent for supportive care. Overall, there was no difference in the rate of myocardial infarction when NPPV was added to supportive care (OR = 1.11; 95% CI, 0.85-1.44). There was no significant variability in treatment effects across studies. Most studies were in patients with ACPE (four studies), followed by studies in patients with COPD (two studies).