Early noninvasive ventilation in general wards for acute respiratory failure: an international, multicentre, open-label, randomised trial.

Summary

In a multinational open-label RCT of 524 adults with mild acute respiratory failure on general wards, early NIV reduced progression to severe respiratory failure (18.5% vs 28.3%; RR 0.65) without differences in 28-day mortality, respiratory complications, or adverse events. Length of stay was similar.

Key Findings

• Early NIV reduced progression to severe acute respiratory failure (18.5% vs 28.3%; RR 0.65, 95% CI 0.48-0.90, P=0.008).
• No differences in 28-day mortality, respiratory complications, or adverse events between groups.
• Hospital length of stay was similar (median 10 vs 9 days; P=0.30).

Clinical Implications

Hospitals can implement protocolized, monitored early NIV on general wards for mild acute respiratory failure to reduce deterioration, with appropriate staff training and escalation pathways.

Limitations

• Open-label design may introduce performance bias.
• Study powered for progression outcome; mortality effects remain uncertain.

Future Directions

Evaluate implementation strategies, cost-effectiveness, and patient selection criteria for ward-based NIV; assess impacts on ICU admission and long-term outcomes.