Cardiorespiratory changes and outcome during noninvasive and invasive mechanical ventilation in ARDS: a comparative study

Background A lung-protective strategy of ventilation is now suggested as a standard of care for patients with acute respiratory distress syndrome (ARDS). The cost of such protective strategy may be prolongation of mechanical ventilation (MV) and poorer prognosis owing to weaning difficulties from the ventilator. Aim The aim was to evaluate the efficacy and outcome of noninvasive ventilation (NIV) as a possible alternative to IMV in patients with ARDS with respect to hemodynamics, gas exchange parameters, incidence of complications, duration of MV, length of hospital stay, ICU survival, and weaning from MV. Patients and methods This randomized controlled study included 52 patients with ARDS of different etiologies; they received either NIV or conventional MV. Data regarding hemodynamics and respiratory changes, including Respiratory Rate (RR), lung compliance, airway resistance, Arterial Blood Gases (ABG), pH, PaCO2, PaO2/FiO2, and LIS, were collected and compared. The reported complications, duration of ventilation, ICU stay, and patients’ outcomes were also compared. Results There was a similar improvement in oxygenation and hemodynamic stability between the NIV group and the IMV group. However, the serious complications were fewer and mortality was lower in the NIV group. There was a statistically significant rise in duration of ventilation in MV (8.33 days) in comparison with NIV (2.52 days). Regarding ICU stay, it ranged from 3 to 18 days, with a mean of 9.02±3.776 days, and there was statistically significant increase in MV group (10.59±1.6 days) in comparison with NIV group (7.32±4.64 days). Weaning was succeeded in 65.4% of NIV group, whereas it was 61.5% in MV group, and there was no statistically significant difference between the studied groups. Mortality was reported in four (15.4%) cases in NIV group, whereas it was reported in 11 (42.3%) cases of invasive MV. Conclusion Considering the advantages and disadvantages of NIV, we believe NIV could be a good alternative option in patients with ARDS. Physicians should try NIV early if there is a respiratory failure risk to reduce mortality, to reduce complication risk, to avoid endotracheal intubation, and to reduce treatment failure.