Sir,
We read with great interest the research article, “A study on the role of NIV in mild to moderate acute respiratory distress syndrome,” published in the previous issue.[1] It was alarming to note that only 44% had successful noninvasive ventilation (NIV) use while the rest of the patients had to be intubated. The mortality quoted for NIV failure group was 46.3% (19 out of 23), which is rather high in the present scenario.
The mortality of moderate adult respiratory distress syndrome (ARDS) in a study done by Thille et al. was only 32%.[2] The author suggests high APACHE scores and delay in intubations as the reasons of the high mortality. The mortality rate is unacceptable and could have been reduced if they were not subjected to further trial of NIV after 1 h. A retrospective study of NIV role in moderate ARDS in esophagectomy patients concluded that it would be an effective option to consider invasive mechanical ventilation in those with P/F ratio <180 after 2 h of NIV.[3] NIV success rates with no significant difference of APACHE score groups was 48.4 in the same study.[3] NIV stands as the first-line approach and may be attempted in ARDS patients with P/F ratio >150.[2] Patients who have P/F ratio of <200 with lung injury score scores >1.5 have to be taken into consideration to go for invasive ventilation.[4]
We manage large number of ARDS patients in our department. ARDS patients (P/F ratio >150) can be treated with NIV while moderate to severe ARDS (P/F ratio <150) should be managed with pressure-controlled mechanical ventilation. Our mortality rates have been 11.4% in the past 3 years.[4]
NIV for ARDS has to be chosen cautiously and needs vigilant monitoring as it can lead to high mortality, even when one makes a decision to shift from NIV to invasive ventilation quickly.
I entirely agree with editorial remarks that the acute inflammation of lung can spread very quickly making the recruitment process slow and delayed. One has to be extremely careful when you choose NIV for ARDS.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Acknowledgments
We gratefully acknowledge management of the hospital for their valuable support.
References
- 1.Singh Sehgal I, Chaudhuri S, Dhooria S, Agarwal R, Chaudhry D. A study on the role of noninvasive ventilation in mild-to-moderate acute respiratory distress syndrome. Indian J Crit Care Med. 2015;19:571–627. doi: 10.4103/0972-5229.167037. [DOI] [PMC free article] [PubMed] [Google Scholar]
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