Abstract
BackgroundInvasive and non-invasive mechanical ventilation (MV) have been combined as sequential MV in the treatment of respiratory failure. However, the effectiveness remains unclear. Here, we performed a randomized controlled study to assess the efficacy and safety of sequential MV in the treatment of tuberculosis with respiratory failure.MethodsForty-four tuberculosis patients diagnosed with respiratory failure were randomly divided into sequential MV group (n = 24) and conventional MV group (n = 20). Initially, the patients in both groups received invasive positive pressure ventilation. When the patients' conditions were relieved, the ventilation modality in sequential MV group was switched to oronasal face mask continuous positive airway pressure until weaning.ResultsAfter treatment, the patients in sequential MV group had similar respiratory rate, heart rate, oxygenation index, alveolo-arterial oxygen partial pressure difference (A-aDO2), blood pH, PaCO2 to those in conventional MV group (all P value > 0.05). There was no significant difference in ventilation time and ICU stay between the two groups (P > 0.05), but sequential MV group significantly reduced the time of invasive ventilation (mean difference (MD): − 36.2 h, 95% confidence interval (CI) − 53.6, − 18.8 h, P < 0.001). Sequential MV group also reduced the incidence of ventilator-associated pneumonia (VAP; relative risk (RR): 0.44, 95% CI 0.24, 0.83, P = 0.006) and atelectasis (RR:0.49, 95% CI 0.24,1.00, P = 0.040).ConclusionsSequential MV was effective in treating tuberculosis with respiratory failure. It showed advantages in reducing invasive ventilation time and ventilator-associated adverse events.Registration number for clinical trialChinese Clinical Trial Registry ChiCTR2000032311, April 21st, 2020
Highlights
Invasive and non-invasive mechanical ventilation (MV) have been combined as sequential MV in the treatment of respiratory failure
The baseline characteristics were similar in conventional MV group and sequential MV group
When FiO2 of ventilation reduced to 50%, the patients in sequential MV group had similar respiratory rate, heart rate, oxygenation index, Alveolo-arterial oxygen partial pressure difference (A-aDO2), PaCO2, blood pH, white blood cells (WBC), percentage of NEU and C-reactive protein (CRP) to those in conventional MV group (Table 2)
Summary
Invasive and non-invasive mechanical ventilation (MV) have been combined as sequential MV in the treatment of respiratory failure. We performed a randomized con‐ trolled study to assess the efficacy and safety of sequential MV in the treatment of tuberculosis with respiratory failure. The most effective way to treat respiratory failure is mechanical ventilation (MV), which supports to relieve symptoms in acute phase and to gain opportunity for the later treatment [5]. The effectiveness of sequential MV for tuberculosis patients with respiratory failure remains unclear. We performed a randomized controlled study to assess the efficacy and safety of sequential non-invasive MV following short-term invasive MV in the treatment of tuberculosis with respiratory failure
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