The third group of the four for which there is compelling evidence for the benefit of noninvasive ventilation includes immunocompromised patients who develop acute respiratory failure (ARF) and need respiratory support. Invasive ventilation is hazardous for patients with impaired immune function due to the high risk of ventilator-associated pneumonia.¹
A study by Antonelli in which 40 patients who had received an organ transplant and developed acute hypoxemic respiratory failure were randomized to either standard therapy (including antibiotic, antifungal or antiviral therapy with oxygen and physiotherapy) or NIV and standard therapy. Eighty percent of patients avoided intubation in the NIV group, whereas 70 percent of patients were intubated in the standard care group. Worth noting is that 6 of the 18 patients who were intubated developed VAP and died.²
The use of NIV to avoid endotracheal intubation to reduce the risk of ventilation associated infections is widely documented. In the article ‘Non-invasive ventilation in immunocompromised patients by Dr. Conti G, Costa R, and Antonelli M, and ‘Noninvasive ventilation for the immunocompromised patient: always appropriate?’ by Bello G, De Pascale G, Antonelli M., it is suggested that NIV is associated with shorter periods of ventilatory assistance and ICU stays, less infectious complications, and lower ICU and hospital mortality compared with invasive mechanical ventilation. This translates to lower hospitalization costs due to shorter periods of hospitalization and medication treatment.