Sequential Mechanical Ventilation Effective in Treating Tuberculosis With Respiratory Failure

The use of sequential mechanical ventilation (MV) has been shown to be safe and effective for improving respiratory function in patients with tuberculosis (TB), with the treatment associated with reduced invasive ventilation time and fewer ventilator-associated adverse events.

A randomized, controlled pilot study was conducted among patients with active TB and respiratory failure being treated in the intensive care unit (ICU) of Beijing Chest Hospital in Beijing, China. Results of the analysis were published in the journal BMC Pulmonary Medicine.

The investigators sought to evaluate the efficacy and safety of sequential, noninvasive MV following the use of short-term invasive MV for the treatment of TB with respiratory failure. A total of 44 patients with TB and respiratory failure were randomly divided into 2 groups: sequential MV group (n=24) and conventional MV group (n=20).

The participants in both groups initially received invasive positive pressure ventilation. When the patients’ symptoms were relieved, the ventilation modality in the sequential MV arm was switched to oronasal face mask continuous positive pressure airway pressure, until weaning.

The primary study endpoint was assessed by detecting respiratory parameters and inflammatory parameters. All respiratory parameters, including respiratory rate, heart rate, oxygenation index, alveolo-arterial oxygen partial pressure difference (A-aDO₂), PACO₂, and blood pH, were recorded prior to treatment (ie, at baseline) and every 8 hours during treatment. All inflammatory parameters were detected at baseline and every 24 hours.

The secondary study endpoint was evaluated by comparing in-hospital outcomes between the 2 groups, including ventilation time, invasive MV time, length of ICU stay, visual analog scale score, total cost, ventilator-associated pneumonia (VAP), and atelectasis.

Following treatment, patients in the sequential MV arm had similar respiratory rates, heart rates, oxygenation indices, A-aDO₂, blood pH, and PACO₂ as individuals in the conventional MV arm (P >.05 for all). Although no statistically significant difference was reported between the 2 groups with respect to ICU stay and ventilation time (P >.05), patients in the sequential MV ventilation group had significantly reduced time using invasive ventilation (mean difference, -36.2 hours; 95% CI, -53.6 to -18.8; P <.001). The incidence of VAP and atelectasis was also significantly reduced in the sequential MV arm (relative risk [RR], 0.44; 95% CI, 0.24-0.83; P =.006 and RR, 0.49; 95% CI, 0.24-1.00; P =.040, respectively).

The researchers concluded that the use of sequential MV can be considered as an optional strategy for the treatment of patients with TB who experience respiratory failure.

Reference

Kang NM, Zhang N, Luo BJ, et al. Sequential non-invasive following short-term invasive mechanical ventilation in the treatment of tuberculosis with respiratory failure: a randomized controlled study. BMC Pulm Med. 2021;21(1):203. doi:10.1186/s12890-021-01563-x