CARING FOR THE CRITICALLY ILL PATIENT Noninvasive Ventilation for Treatment of Acute Respiratory Failure in Patients Undergoing Solid Organ Transplantation A Randomized Trial

IN THE PAST 2 DECADES, ADVANCEments in immunosuppressive strategies and major breakthroughs in surgical and organ preservation techniques have transformed organ transplantation into a therapy for an increasing population of patients with endstage organ failure. Although preventing rejection remains the principle focus in improving overall survival statistics, pulmonary complications following transplantation are responsible for most morbidity and contribute substantially to the mortality associated with various organ transplantation procedures. Approximately 5% of patients undergoingrenal,hepatic, cardiac,orpulmonary transplantationdeveloppneumoniainthe period after transplantation, which has anassociatedcrudemortalityof37%. In patients with acute respiratory failure (ARF), endotracheal intubation is the single most important predisposing factor for developing nosocomial bacterial pneumonia. Noninvasive positive-pressure ventilation refers to the delivery of assisted mechanical ventilation without the need for an invasive artificial airway. In ARF, when noninvasive ventilation (NIV) is effective in avoiding endotracheal intubation, the incidence of bacterial pneumonia is extremely low. Small, uncontrolled studies in recipients of lung transplants have reported that NIV permits ealier extuAuthor Affiliations are listed at the end of this article. CorrespondingAuthorandReprints: MassimoAntonelli, MD, Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, 1 Largo F. Vito, 00168 Rome, Italy (e-mail: [email protected]). Caring for the Critically Ill Patient Section Editor: Deborah J. Cook, MD, Consulting Editor, JAMA. Advisory Board: David Bihari, MD; Christian BrunBuisson, MD; Timothy Evans, MD; John Heffner, MD; Norman Paradis, MD. Context Noninvasive ventilation (NIV) has been associated with lower rates of endotracheal intubation in populations of patients with acute respiratory failure.