human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Introduction Noninvasive ventilation ( NIV ) , as a weaning-facilitating strategy in predominantly chronic obstructive pulmonary disease ( COPD ) mechanically ventilated patients , is associated with reduced ventilator-associated pneumonia , total duration of mechanical ventilation , length of intensive care unit ( ICU ) and hospital stay , and mortality . However , this benefit after planned extubation in patients with acute respiratory failure of various etiologies remains to be eluci date d. The aim of this study was to determine the efficacy of NIV applied immediately after planned extubation in contrast to oxygen mask ( OM ) in patients with acute respiratory failure ( ARF ) . Methods A r and omized , prospect i ve , controlled , unblinded clinical study in a single center of a 24-bed adult general ICU in a university hospital was carried out in a 12-month period . Included patients met extubation criteria with at least 72 hours of mechanical ventilation due to acute respiratory failure , after following the ICU weaning protocol . Patients were r and omized immediately before elective extubation , being r and omly allocated to one of the study groups : NIV or OM . We compared both groups regarding gas exchange 15 minutes , 2 hours , and 24 hours after extubation , reintubation rate after 48 hours , duration of mechanical ventilation , ICU length of stay , and hospital mortality . Results Forty patients were r and omized to receive NIV ( 20 patients ) or OM ( 20 patients ) after the following extubation criteria were met : pressure support ( PSV ) of 7 cm H2O , positive end-expiratory pressure ( PEEP ) of 5 cm H2O , oxygen inspiratory fraction ( FiO2 ) ≤ 40 % , arterial oxygen saturation ( SaO2 ) ≥ 90 % , and ratio of respiratory rate and tidal volume in liters ( f/TV ) < 105 . Comparing the 20 patients ( NIV ) with the 18 patients ( OM ) that finished the study 48 hours after extubation , the rate of reintubation  in NIV group was 5 % and 39 % in OM group ( P = 0.016 ) . Relative risk for reintubation was 0.13 ( CI = 0.017 to 0.946 ) . Absolute risk reduction for reintubation showed a decrease of 33.9 % , and analysis of the number needed to treat was three . No difference was found in the length of ICU stay ( P = 0.681 ) . Hospital mortality was zero in NIV group and 22.2 % in OM group ( P = 0.041 ) . Conclusions In this study population , NIV prevented 48 hours reintubation if applied immediately after elective extubation in patients with more than 3 days of ARF when compared with the OM group . Trial Registration numberIS RCT N : 41524441 RATIONALE Respiratory failure after extubation and reintubation is associated with increased morbidity and mortality . OBJECTIVES To assess the efficacy of noninvasive ventilation in averting respiratory failure after extubation in patients at increased risk . METHODS A prospect i ve r and omized controlled trial was conducted in 162 mechanically ventilated patients who tolerated a spontaneous breathing trial after recovery from the acute episode but had increased risk for respiratory failure after extubation . Patients were r and omly allocated after extubation to receive noninvasive ventilation for 24 h ( n = 79 ) , or conventional management with oxygen therapy ( control group , n = 83 ) . MEASUREMENTS AND MAIN RESULTS The primary end-point variable was the decrease in respiratory failure after extubation . In the noninvasive ventilation group , respiratory failure after extubation was less frequent ( 13 , 16 vs. 27 , 33 % ; p = 0.029 ) and the intensive care unit mortality was lower ( 2 , 3 versus 12 , 14 % ; p = 0.015 ) . However , 90-d survival did not change significantly between groups . Separate analyses of patients without and with hypercapnia ( arterial CO(2 ) tension greater than 45 mm Hg ) during the spontaneous breathing trial showed that noninvasive ventilation improved intensive care unit mortality ( 0 vs. 4 , 18 % ; p = 0.035 ) and 90-d survival ( p = 0.006 ) in hypercapnic patients only ; of them , 98 % had chronic respiratory disorders . CONCLUSIONS The early use of noninvasive ventilation averted respiratory failure after extubation and decreased intensive care unit mortality among patients at increased risk . The beneficial effect of noninvasive ventilation in improving survival of hypercapnic patients with chronic respiratory disorders warrants a new prospect i ve clinical trial Introduction Contemporary information on mechanical ventilation ( MV ) use in emerging countries is limited . Moreover , most epidemiological studies on ventilatory support were carried out before significant developments , such as lung protective ventilation or broader application of non-invasive ventilation ( NIV ) . We aim ed to evaluate the clinical characteristics , outcomes and risk factors for hospital mortality and failure of NIV in patients requiring ventilatory support in Brazilian intensive care units ( ICU ) . Methods In a multicenter , prospect i ve , cohort study , a total of 773 adult patients admitted to 45 ICUs over a two-month period requiring invasive ventilation or NIV for more than 24 hours were evaluated .  Causes of ventilatory support , prior chronic health status and physiological data were assessed . Multivariate analysis was used to identifiy variables associated with hospital mortality and NIV failure . Results Invasive MV and NIV were used as initial ventilatory support in 622 ( 80 % ) and 151 ( 20 % ) patients . Failure with subsequent intubation occurred in 54 % of NIV patients . The main reasons for ventilatory support were pneumonia ( 27 % ) , neurologic disorders ( 19 % ) and non-pulmonary sepsis ( 12 % ) . ICU and hospital mortality rates were 34 % and 42 % . Using the Berlin definition , acute respiratory distress syndrome ( ARDS ) was diagnosed in 31 % of the patients with a hospital mortality of 52 % . In the multivariate analysis , age ( odds ratio ( OR ) , 1.03 ; 95 % confidence interval ( CI ) , 1.01 to 1.03 ) , comorbidities ( OR , 2.30 ; 95 % CI , 1.28 to 3.17 ) , associated organ failures ( OR , 1.12 ; 95 % CI , 1.05 to 1.20 ) , moderate ( OR , 1.92 ; 95 % CI , 1.10 to 3.35 ) to severe ARDS ( OR , 2.12 ; 95 % CI , 1.01 to 4.41 ) , cumulative fluid balance over the first 72 h of ICU ( OR , 2.44 ; 95 % CI , 1.39 to 4.28 ) , higher lactate ( OR , 1.78 ; 95 % CI , 1.27 to 2.50 ) , invasive MV ( OR , 2.67 ; 95 % CI , 1.32 to 5.39 ) and NIV failure ( OR , 3.95 ; 95 % CI , 1.74 to 8.99 ) were independently associated with hospital mortality . The predictors of NIV failure were the severity of associated organ dysfunctions ( OR , 1.20 ; 95 % CI , 1.05 to 1.34 ) , ARDS ( OR , 2.31 ; 95 % CI , 1.10 to 4.82 ) and positive fluid balance ( OR , 2.09 ; 95 % CI , 1.02 to 4.30 ) . Conclusions Current mortality of ventilated patients in Brazil is elevated . Implementation of judicious fluid therapy and a watchful use and monitoring of NIV patients are potential targets to improve outcomes in this setting .Trial registration Clinical Trials.gov NCT01268410 BACKGROUND Whether noninvasive ventilation should be administered in patients with acute hypoxemic respiratory failure is debated . Therapy with high-flow oxygen through a nasal cannula may offer an alternative in patients with hypoxemia . METHODS We performed a multicenter , open-label trial in which we r and omly assigned patients without hypercapnia who had acute hypoxemic respiratory failure and a ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen of 300 mm Hg or less to high-flow oxygen therapy , st and ard oxygen therapy delivered through a face mask , or noninvasive positive-pressure ventilation . The primary outcome was the proportion of patients intubated at day 28 ; secondary outcomes included all-cause mortality in the intensive care unit and at 90 days and the number of ventilator-free days at day 28 . RESULTS A total of 310 patients were included in the analyses .  The intubation rate ( primary outcome ) was 38 % ( 40 of 106 patients ) in the high-flow-oxygen group , 47 % ( 44 of 94 ) in the st and ard group , and 50 % ( 55 of 110 ) in the noninvasive-ventilation group ( P=0.18 for all comparisons ) . The number of ventilator-free days at day 28 was significantly higher in the high-flow-oxygen group ( 24±8 days , vs. 22±10 in the st and ard-oxygen group and 19±12 in the noninvasive-ventilation group ; P=0.02 for all comparisons ) . The hazard ratio for death at 90 days was 2.01 ( 95 % confidence interval [ CI ] , 1.01 to 3.99 ) with st and ard oxygen versus high-flow oxygen ( P=0.046 ) and 2.50 ( 95 % CI , 1.31 to 4.78 ) with noninvasive ventilation versus high-flow oxygen ( P=0.006 ) . CONCLUSIONS In patients with nonhypercapnic acute hypoxemic respiratory failure , treatment with high-flow oxygen , st and ard oxygen , or noninvasive ventilation did not result in significantly different intubation rates . There was a significant difference in favor of high-flow oxygen in 90-day mortality . ( Funded by the Programme Hospitalier de Recherche Clinique Interrégional 2010 of the French Ministry of Health ; FLORALI Clinical Trials.gov number , NCT01320384 . ) IMPORTANCE Noninvasive ventilation has been recommended to decrease mortality among immunocompromised patients with hypoxemic acute respiratory failure . However , its effectiveness for this indication remains unclear . OBJECTIVE To determine whether early noninvasive ventilation improved survival in immunocompromised patients with nonhypercapnic acute hypoxemic respiratory failure . DESIGN , SETTING , AND PARTICIPANTS Multicenter r and omized trial conducted among 374 critically ill immunocompromised patients , of whom 317 ( 84.7 % ) were receiving treatment for hematologic malignancies or solid tumors , at 28 intensive care units ( ICUs ) in France and Belgium between August 12 , 2013 , and January 2 , 2015 . INTERVENTIONS Patients were r and omly assigned to early noninvasive ventilation ( n = 191 ) or oxygen therapy alone ( n = 183 ) . MAIN OUTCOMES AND MEASURES The primary outcome was day-28 mortality . Secondary outcomes were intubation , Sequential Organ Failure Assessment score on day 3 , ICU-acquired infections , duration of mechanical ventilation , and ICU length of stay . RESULTS At r and omization , median oxygen flow was 9 L/min ( interquartile range , 5 - 15 ) in the noninvasive ventilation group and 9 L/min ( interquartile range , 6 - 15 ) in the oxygen group . All patients in the noninvasive ventilation group received the first noninvasive ventilation session immediately after r and omization . On day 28 after r and omization , 46 deaths ( 24.1 % ) had occurred in the noninvasive ventilation group vs 50 ( 27.3 % ) in the oxygen group ( absolute difference , -3.2 [ 95 % CI , -12.1 to 5.6 ] ; P = .47 ) . Oxygenation failure occurred in 155 patients overall ( 41.4 % ) , 73 ( 38.2 % ) in the noninvasive ventilation group and 82 ( 44.8 % ) in the oxygen group ( absolute difference , -6.6 [ 95 % CI , -16.6 to 3.4 ] ; P = .20 ) . There were no significant differences in ICU-acquired infections , duration of mechanical ventilation , or lengths of ICU or hospital stays . CONCLUSIONS AND RELEVANCE Among immunocompromised patients admitted to the ICU with hypoxemic acute respiratory failure , early noninvasive ventilation compared with oxygen therapy alone did not reduce 28-day mortality . However , study power was limited . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01915719 Abstract Objective . To compare the acute effects of noninvasive pressure support ventilation ( NIPSV ) in non- 
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***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Introduction Noninvasive ventilation ( NIV ) , as a weaning-facilitating strategy in predominantly chronic obstructive pulmonary disease ( COPD ) mechanically ventilated patients , is associated with reduced ventilator-associated pneumonia , total duration of mechanical ventilation , length of intensive care unit ( ICU ) and hospital stay , and mortality . However , this benefit after planned extubation in patients with acute respiratory failure of various etiologies remains to be eluci date d. The aim of this study was to determine the efficacy of NIV applied immediately after planned extubation in contrast to oxygen mask ( OM ) in patients with acute respiratory failure ( ARF ) . Methods A r and omized , prospect i ve , controlled , unblinded clinical study in a single center of a 24-bed adult general ICU in a university hospital was carried out in a 12-month period . Included patients met extubation criteria with at least 72 hours of mechanical ventilation due to acute respiratory failure , after following the ICU weaning protocol . Patients were r and omized immediately before elective extubation , being r and omly allocated to one of the study groups : NIV or OM . We compared both groups regarding gas exchange 15 minutes , 2 hours , and 24 hours after extubation , reintubation rate after 48 hours , duration of mechanical ventilation , ICU length of stay , and hospital mortality . Results Forty patients were r and omized to receive NIV ( 20 patients ) or OM ( 20 patients ) after the following extubation criteria were met : pressure support ( PSV ) of 7 cm H2O , positive end-expiratory pressure ( PEEP ) of 5 cm H2O , oxygen inspiratory fraction ( FiO2 ) ≤ 40 % , arterial oxygen saturation ( SaO2 ) ≥ 90 % , and ratio of respiratory rate and tidal volume in liters ( f/TV ) < 105 . Comparing the 20 patients ( NIV ) with the 18 patients ( OM ) that finished the study 48 hours after extubation , the rate of reintubation  in NIV group was 5 % and 39 % in OM group ( P = 0.016 ) . Relative risk for reintubation was 0.13 ( CI = 0.017 to 0.946 ) . Absolute risk reduction for reintubation showed a decrease of 33.9 % , and analysis of the number needed to treat was three . No difference was found in the length of ICU stay ( P = 0.681 ) . Hospital mortality was zero in NIV group and 22.2 % in OM group ( P = 0.041 ) . Conclusions In this study population , NIV prevented 48 hours reintubation if applied immediately after elective extubation in patients with more than 3 days of ARF when compared with the OM group . Trial Registration numberIS RCT N : 41524441 RATIONALE Respiratory failure after extubation and reintubation is associated with increased morbidity and mortality . OBJECTIVES To assess the efficacy of noninvasive ventilation in averting respiratory failure after extubation in patients at increased risk . METHODS A prospect i ve r and omized controlled trial was conducted in 162 mechanically ventilated patients who tolerated a spontaneous breathing trial after recovery from the acute episode but had increased risk for respiratory failure after extubation . Patients were r and omly allocated after extubation to receive noninvasive ventilation for 24 h ( n = 79 ) , or conventional management with oxygen therapy ( control group , n = 83 ) . MEASUREMENTS AND MAIN RESULTS The primary end-point variable was the decrease in respiratory failure after extubation . In the noninvasive ventilation group , respiratory failure after extubation was less frequent ( 13 , 16 vs. 27 , 33 % ; p = 0.029 ) and the intensive care unit mortality was lower ( 2 , 3 versus 12 , 14 % ; p = 0.015 ) . However , 90-d survival did not change significantly between groups . Separate analyses of patients without and with hypercapnia ( arterial CO(2 ) tension greater than 45 mm Hg ) during the spontaneous breathing trial showed that noninvasive ventilation improved intensive care unit mortality ( 0 vs. 4 , 18 % ; p = 0.035 ) and 90-d survival ( p = 0.006 ) in hypercapnic patients only ; of them , 98 % had chronic respiratory disorders . CONCLUSIONS The early use of noninvasive ventilation averted respiratory failure after extubation and decreased intensive care unit mortality among patients at increased risk . The beneficial effect of noninvasive ventilation in improving survival of hypercapnic patients with chronic respiratory disorders warrants a new prospect i ve clinical trial Introduction Contemporary information on mechanical ventilation ( MV ) use in emerging countries is limited . Moreover , most epidemiological studies on ventilatory support were carried out before significant developments , such as lung protective ventilation or broader application of non-invasive ventilation ( NIV ) . We aim ed to evaluate the clinical characteristics , outcomes and risk factors for hospital mortality and failure of NIV in patients requiring ventilatory support in Brazilian intensive care units ( ICU ) . Methods In a multicenter , prospect i ve , cohort study , a total of 773 adult patients admitted to 45 ICUs over a two-month period requiring invasive ventilation or NIV for more than 24 hours were evaluated .  Causes of ventilatory support , prior chronic health status and physiological data were assessed . Multivariate analysis was used to identifiy variables associated with hospital mortality and NIV failure . Results Invasive MV and NIV were used as initial ventilatory support in 622 ( 80 % ) and 151 ( 20 % ) patients . Failure with subsequent intubation occurred in 54 % of NIV patients . The main reasons for ventilatory support were pneumonia ( 27 % ) , neurologic disorders ( 19 % ) and non-pulmonary sepsis ( 12 % ) . ICU and hospital mortality rates were 34 % and 42 % . Using the Berlin definition , acute respiratory distress syndrome ( ARDS ) was diagnosed in 31 % of the patients with a hospital mortality of 52 % . In the multivariate analysis , age ( odds ratio ( OR ) , 1.03 ; 95 % confidence interval ( CI ) , 1.01 to 1.03 ) , comorbidities ( OR , 2.30 ; 95 % CI , 1.28 to 3.17 ) , associated organ failures ( OR , 1.12 ; 95 % CI , 1.05 to 1.20 ) , moderate ( OR , 1.92 ; 95 % CI , 1.10 to 3.35 ) to severe ARDS ( OR , 2.12 ; 95 % CI , 1.01 to 4.41 ) , cumulative fluid balance over the first 72 h of ICU ( OR , 2.44 ; 95 % CI , 1.39 to 4.28 ) , higher lactate ( OR , 1.78 ; 95 % CI , 1.27 to 2.50 ) , invasive MV ( OR , 2.67 ; 95 % CI , 1.32 to 5.39 ) and NIV failure ( OR , 3.95 ; 95 % CI , 1.74 to 8.99 ) were independently associated with hospital mortality . The predictors of NIV failure were the severity of associated organ dysfunctions ( OR , 1.20 ; 95 % CI , 1.05 to 1.34 ) , ARDS ( OR , 2.31 ; 95 % CI , 1.10 to 4.82 ) and positive fluid balance ( OR , 2.09 ; 95 % CI , 1.02 to 4.30 ) . Conclusions Current mortality of ventilated patients in Brazil is elevated . Implementation of judicious fluid therapy and a watchful use and monitoring of NIV patients are potential targets to improve outcomes in this setting .Trial registration Clinical Trials.gov NCT01268410 BACKGROUND Whether noninvasive ventilation should be administered in patients with acute hypoxemic respiratory failure is debated . Therapy with high-flow oxygen through a nasal cannula may offer an alternative in patients with hypoxemia . METHODS We performed a multicenter , open-label trial in which we r and omly assigned patients without hypercapnia who had acute hypoxemic respiratory failure and a ratio of the partial pressure of arterial oxygen to the fraction of inspired oxygen of 300 mm Hg or less to high-flow oxygen therapy , st and ard oxygen therapy delivered through a face mask , or noninvasive positive-pressure ventilation . The primary outcome was the proportion of patients intubated at day 28 ; secondary outcomes included all-cause mortality in the intensive care unit and at 90 days and the number of ventilator-free days at day 28 . RESULTS A total of 310 patients were included in the analyses .  The intubation rate ( primary outcome ) was 38 % ( 40 of 106 patients ) in the high-flow-oxygen group , 47 % ( 44 of 94 ) in the st and ard group , and 50 % ( 55 of 110 ) in the noninvasive-ventilation group ( P=0.18 for all comparisons ) . The number of ventilator-free days at day 28 was significantly higher in the high-flow-oxygen group ( 24±8 days , vs. 22±10 in the st and ard-oxygen group and 19±12 in the noninvasive-ventilation group ; P=0.02 for all comparisons ) . The hazard ratio for death at 90 days was 2.01 ( 95 % confidence interval [ CI ] , 1.01 to 3.99 ) with st and ard oxygen versus high-flow oxygen ( P=0.046 ) and 2.50 ( 95 % CI , 1.31 to 4.78 ) with noninvasive ventilation versus high-flow oxygen ( P=0.006 ) . CONCLUSIONS In patients with nonhypercapnic acute hypoxemic respiratory failure , treatment with high-flow oxygen , st and ard oxygen , or noninvasive ventilation did not result in significantly different intubation rates . There was a significant difference in favor of high-flow oxygen in 90-day mortality . ( Funded by the Programme Hospitalier de Recherche Clinique Interrégional 2010 of the French Ministry of Health ; FLORALI Clinical Trials.gov number , NCT01320384 . ) IMPORTANCE Noninvasive ventilation has been recommended to decrease mortality among immunocompromised patients with hypoxemic acute respiratory failure . However , its effectiveness for this indication remains unclear . OBJECTIVE To determine whether early noninvasive ventilation improved survival in immunocompromised patients with nonhypercapnic acute hypoxemic respiratory failure . DESIGN , SETTING , AND PARTICIPANTS Multicenter r and omized trial conducted among 374 critically ill immunocompromised patients , of whom 317 ( 84.7 % ) were receiving treatment for hematologic malignancies or solid tumors , at 28 intensive care units ( ICUs ) in France and Belgium between August 12 , 2013 , and January 2 , 2015 . INTERVENTIONS Patients were r and omly assigned to early noninvasive ventilation ( n = 191 ) or oxygen therapy alone ( n = 183 ) . MAIN OUTCOMES AND MEASURES The primary outcome was day-28 mortality . Secondary outcomes were intubation , Sequential Organ Failure Assessment score on day 3 , ICU-acquired infections , duration of mechanical ventilation , and ICU length of stay . RESULTS At r and omization , median oxygen flow was 9 L/min ( interquartile range , 5 - 15 ) in the noninvasive ventilation group and 9 L/min ( interquartile range , 6 - 15 ) in the oxygen group . All patients in the noninvasive ventilation group received the first noninvasive ventilation session immediately after r and omization . On day 28 after r and omization , 46 deaths ( 24.1 % ) had occurred in the noninvasive ventilation group vs 50 ( 27.3 % ) in the oxygen group ( absolute difference , -3.2 [ 95 % CI , -12.1 to 5.6 ] ; P = .47 ) . Oxygenation failure occurred in 155 patients overall ( 41.4 % ) , 73 ( 38.2 % ) in the noninvasive ventilation group and 82 ( 44.8 % ) in the oxygen group ( absolute difference , -6.6 [ 95 % CI , -16.6 to 3.4 ] ; P = .20 ) . There were no significant differences in ICU-acquired infections , duration of mechanical ventilation , or lengths of ICU or hospital stays . CONCLUSIONS AND RELEVANCE Among immunocompromised patients admitted to the ICU with hypoxemic acute respiratory failure , early noninvasive ventilation compared with oxygen therapy alone did not reduce 28-day mortality . However , study power was limited . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01915719 Abstract Objective . To compare the acute effects of noninvasive pressure support ventilation ( NIPSV ) in non- 
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