• Barbas Carmen Sílvia Valente CS 1 Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil ; 2 Pulmonary Division, Heart Institute and and Ary Serpa Neto.
• 1 Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil ; 2 Pulmonary Division, Heart Institute and Hospital das Clinicas of University of São Paulo Medical School, São Paulo, Brazil ; 3 Program of Post-Graduation, Research and Innovation, Faculdade de Medicina do ABC, São Paulo, Brazil ; 4 Department of Intensive Care, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
• J Thorac Dis. 2016 Jan 1; 8 (1): E100-3.

AbstractOn October 27, 2015, Lemile and colleagues published an article in JAMA entitled "Effect of Noninvasive Ventilation vs. Oxygen Therapy on Mortality among Immunocompromised Patients with Acute Respiratory Failure: A Randomized Clinical Trial", which investigated the effects of non-invasive ventilation (NIV) in 28-day mortality of 374 critically ill immunosuppressed patients. The authors found that among immunosuppressed patients admitted to the intensive care unit (ICU) with hypoxemic acute respiratory failure, early NIV compared with oxygen therapy alone did not reduce 28-day mortality. Furthermore, different from the previous publications, there were no significant differences in ICU-acquired infections, duration of mechanical ventilation, or lengths of ICU or hospital stays. The study power was limited, median oxygen flow used was higher than used before or 9 L/min, NIV settings provided tidal volumes higher than what is considered protective nowadays or from 7 to 10 mL/kg of ideal body weight and the hypoxemic respiratory failure was moderate to severe (median PaO2/FIO2 was around 140), a group prone to failure in noninvasive ventilatory support. Doubts arose regarding the early use of NIV in immunosuppressed critically ill patients with non-hypercapnic hypoxemic respiratory failure that need to be solved in the near future.

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