NIVAS TRIAL

Effect of NIV on Tracheal Intubation Rate In Patients With Hypoxemic Respiratory Failure Following Abdominal Surgery

This was an open label,Multicenter,parallel group,randomized controlled trial done across 20 ICUs in FRANCE. Data collected from May 2013-September 2014.

293 patients were analyzed,who underwent abdominal surgery and developed hypoxemic respiratory failure within 7 days of the surgical procedure.

Patients were randomly assigned to either receive standard oxygen therapy(upto 15l/min to an spo2 of 94% or higher) OR NIV delivered by a face mask(IPAP=5-15 cm H2O,PEEP=5-10 cmH2O,,FiO2 titrated to an spo2 of 94% or higher).

Outcome:

Primary Outcome:

1. RE-INTUBATION WITHIN 7 DAYS: NIV(33.1%) vs O2(45.5%).

Secondary Outcome:

1. 30 DAY RE-INTUBATION: NIV(38.5%) vs O2(49.7%).
2. 30 DAY PNEUMONIA: NIV(14.6%) vs O2(29.7%).
3. 30 DAY HEALTH CARE ASSOCIATED INFECTION: NIV(31.4%) vs O2(49.2%).
4. LOS ICU: NIV(7 DAYS) vs O2(8 DAYS).
5. 30 DAY MORTALITY: NIV(10.1%) vs O2(15.3%).

So,we can say that NIV do reduce re-intubation rates in patients with hypoxemic respiratory failure following abdominal surgery, without raising the mortality or risks of adverse effects e.g.,aspiration pneumonitis/HCAI(health care associated infection)/LOS ICU(length of stay in ICU).

BUT,BUT, the significant result seems relatively fragile considering the bias from unblinded clinicians and lack of generalizability to all patients and health care systems,as there was a heavy inclination towards laparotomy(91%) vs laparoscopy(11%).

What about HFNC  in comparison to NIV for the same patient category?which would be better??

What do you think?

JAMA. 2016 Apr 5;315(13):1345-53. doi: 10.1001/jama.2016.2706.

By Dr.Kishalaya Chakraborty for CCEM Journal.