What are the intubation and mortality benefits of noninvasive ventilation (NIV) for congestive heart failure (CHF)?

Updated: Jun 18, 2020
  • Author: Guy W Soo Hoo, MD, MPH; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Answer

Answer

The largest randomized trial comparing oxygen, CPAP, and noninvasive ventilation as adjunctive treatments to conventional therapy in patients with CHF did not identify any intubation or mortality benefit. [26] Patients with CPAP and noninvasive ventilation (BiPAP) did have more rapid resolution of symptoms and correction of gas exchange abnormalities and pH compared with the oxygen group. No difference was noted between CPAP and noninvasive ventilation (BiPAP).

Do note, however, that this trial randomized and treated patients in an emergency department setting, and treatment with noninvasive ventilation averaged approximately 2 hours. Admission to a critical care unit was an outcome measure, and the overall intubation rate for all of the groups was less than 3%. This is distinctly different from other trials, in which the intubation rates for the control groups were approximately 31%. This raises some question about the comparability of these three groups of patients with patients reported in other trials, which included patients requiring ICU-level care.


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