Date of Final Oral Examination (Defense)

8-2010

Type of Culminating Activity

Thesis

Degree Title

Master of Science in Interdisciplinary Studies

Department

Interdisciplinary Studies

Major Advisor

Uwe Reischl, Ph.D. M.D.

Abstract

Introduction: In the last two decades, there has been strong evidence supporting the use of noninvasive ventilation (NIV) in COPD cases. While there are advocates in favor of the use of NIV in patients presented with acute hypoxemic respiratory failure (AHRF) non-related to COPD nor chest trauma, efficacy of NIV in these cases is still heatedly debated in the medical research field.

Objective: To critically assess the existing scientific evidence regarding efficacy of NIV as an adjunct therapy, the endotracheal intubation rate, intensive care and hospital length of stay, fatal complications, and mortality rate in patients presented with AHRF in non-COPD, non-trauma situations.

Data Source: A search of PubMed, MEDLINE database from 1990 to 2010, Cochrane Library, and EMBASE from 1990 to 2010 were also conducted.

Study Selection: Randomized controlled trials (n=11) that assessed the efficacy of NIV in patient with AHRF not related to COPD nor trauma, in addition to various cohort studies, observational studies, and some selective conference proceedings that are considered potentially relevant to the topic.

Results:The use of NIV showed a statistically significant decrease in intubation and mortality rates in patients with immunosuppression who developed AHRF. There were also encouraging results in patients who underwent lung resection, and post-abdominal surgical procedures who received NIV to treat AHRF.

Conclusion: This systematic review of a number of RCTs suggests that the use of NIV decreases the need for endotracheal intubation, fatal complications, and mortality rate. However, due to the diversity of study population, there is a great need for more specific trials on less heterogeneous patients with AHRF.

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