Objective To evaluate the
efficacy of noninvasive
positive-pressure ventilation (NPPV) on acute
respiratory failure (ARF) in
elderly patients with severe
community -acquired
pneumonia (CAP).
Methods 321 CAP
patients with ARF
aged over 65 years [(75.6±12.2) years old in averag] were randomly treated with NPPV (n=162) and the standard
oxygen therapy (n=159).
Intubation rate,ARF control rate and total
mortality were compared between the two groups,and the
risk factors were analyzed.Results 90% of 321
patients presented with
hypoxemic respiratory failure .Compared with standard
therapy group,the
intubation rate was lower in NPPV group (46.9% vs.64.2%,x2=9.652,P<0.01).However,there were no differences in ARF control rate(77.9% vs.72.3%,x2 =1.274,P>0.05),overall 30-day
mortality and 90-day
survival between the two groups.The overall
mortality in NPPV group was higher in
treatment failure cases than in
treatment success cases (48.7% vs.11.6%,x2=26.900,P<0.01).The independent
risk factors for
death were
treatment failure in NPPV,higher
simplified acute physiology score assessment,old age and mutilobar infiltrate.Conclusions NPPV can decrease the
intubation rate in CAP
patients with
acute hypoxemic respiratory failure ,but the overall
efficacy is not significant.Delayed
intubation should be avoided when NPPV is to be applicated.