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

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Other Key Findings of the Comparative Effectiveness Review (1 of 3)

Four studies evaluated the relative effects of noninvasive positive-pressure ventilation (NPPV) versus invasive ventilation on hospital-acquired pneumonia in 405 patients. Overall, there was a markedly lower risk of pneumonia with NPPV (summary odds ratio [OR] = 0.15; 95-percent confidence interval [95% CI], 0.08 to 0.30). There was no significant variability in treatment effects across studies. Two of the four studies were conducted in patients with chronic obstructive pulmonary disease, while the remaining two studies were conducted in mixed patient populations.

Four studies compared NPPV to invasive ventilation and reported effects on mortality. The etiology of acute respiratory failure was COPD (two studies) and mixed (two studies). One study was of good quality; the other studies were of fair quality. The mortality rate for invasive ventilation ranged from 6–47 percent. Overall, there was no difference in mortality when NPPV was used versus invasive ventilation (summary OR = 0.61; 95% CI, 0.33 to 1.12).