Acute Lung Injury/Acute Respiratory Distress Syndrome
Despite advances in management, a diagnosis of acute lung injury or acute respiratory distress syndrome portends a high mortality rate. Studies comparing mortality and rates of ventilator-acquired pneumonia associated with NIV versus invasive ventilation have produced mixed findings. A meta-analysis of NIV use in acute lung injury by Agarwal et al advised cautious use of NIV in this high-risk population, as their investigation identified a 50% NIV failure rate, with a 48% intubation rate and 35% mortality.82 A more recent trial by Zhan et al found that the NIV group had a lower rate of intubation compared to controls.83 These authors concluded that use of NIV may be safe in selected patients who are observed carefully.
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