Sequential Non-Invasive Following Short-Term Invasive Mechanical Ventilation in the Treatment of Tuberculosis with Respiratory Failure: A Randomized Controlled Study

Abstract

Background: Invasive and non-invasive mechanical ventilation (MV) have been combined as sequential MV (SMV) in the treatment of respiratory failure. However, the effectiveness remains unclear. Here, we performed a randomized controlled study to assess the efficacy and safety of SMV in the treatment of tuberculosis with respiratory failure.Methods. Forty-four tuberculosis patients diagnosed with respiratory failure were randomly divided into SMV group (n=24) and conventional MV (CMV) group (n=20). Initially, the patients in both groups received invasive positive pressure ventilation (IPPV). When the patients' conditions were relieved, the ventilation modality in SMV group was switched to oronasal face continuous positive airway pressure (CPAP) until weaning. Results. After treatment, the patients in SMV group had similar respiratory rate, heart rate, oxygenation index, alveolo-arterial oxygen partial pressure difference (A-aDO2), blood pH, PaCO2 to those in CMV group (all P value>0.05). There was no significant difference in ventilation time and ICU stay between the two groups (P>0.05), but SMV group significantly reduced the time of invasive ventilation (mean difference (MD):-36.2 hrs,95% confidence interval (CI):-53.6,-18.8 hrs,P<0.001). SMV group also reduced the incidence of ventilator-associated pneumonia (VAP;relative risk (RR):0.44,95% CI:0.24,0.83,P=0.006) and atelectasis (RR:0.49,95% CI:0.24,1.00,P=0.040). Conclusions. SMV was effective in treating tuberculosis with respiratory failure. It showed advantages in reducing invasive ventilation time and ventilator-associated adverse events.