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: Objective To compare the physiological effects and the clinical efficacy of continuous positive airway pressure ( CPAP ) vs st and ard medical treatment in elderly patients ( ≥75 years ) with acute hypoxemic respiratory failure related to cardiogenic pulmonary edema . Design A prospect i ve , r and omized , concealed , and unblinded study of 89 consecutive patients who were admitted to the emergency departments of one general , and three teaching , hospitals . Intervention Patients were r and omly assigned to receive st and ard medical treatment alone ( n=46 ) or st and ard medical treatment plus CPAP ( n=43 ) . Measurements Improvement in PaO2/FIO2 ratio , complications , length of hospital stay , early 48-h and overall mortality , compared between the CPAP and st and ard treatment groups . Results Study groups were comparable with regard to baseline physiological and clinical characteristics ( age , sex ratio , autonomy , medical history , cause of pulmonary edema ) . Within 1 h , noninvasive continuous positive airway pressure led to decreased respiratory rate ( respiratory rate , 27±7 vs 35±6 breaths/min ; p=0.009 ) , and improved oxygenation ( PaO2/FIO2 , 306±104 vs 157±71 ; p=0.004 ) compared with baseline , whereas no differences were observed within the st and ard treatment group . Severe complications occurred in 17 patients in the st and ard treatment group , vs 4 patients in the noninvasive continuous positive airway pressure group ( p=0.002 ) . Early 48-h mortality was 7 % in the noninvasive continuous positive airway pressure group , compared with 24 % in the st and ard treatment group ( p=0.017 ) ; however , no sustained benefits were observed during the overall hospital stay . Conclusion Noninvasive continuous positive airway pressure promotes early clinical improvement in elderly patients attending emergency departments for a severe pulmonary edema , but only reduces early 48-h mortality CONTEXT Continuous positive airway pressure ( CPAP ) is widely used in the belief that it may reduce the need for intubation and mechanical ventilation in patients with acute hypoxemic respiratory insufficiency . OBJECTIVE To compare the physiologic effects and the clinical efficacy of CPAP vs st and ard oxygen therapy in patients with acute hypoxemic , nonhypercapnic respiratory insufficiency . DESIGN , SETTING , AND PATIENTS R and omized , concealed , and unblinded trial of 123 consecutive adult patients who were admitted to 6 intensive care units between September 1997 and January 1999 with a PaO(2)/FIO(2 ) ratio of 300 mm Hg or less due to bilateral pulmonary edema ( n = 102 with acute lung injury and n = 21 with cardiac disease ) . INTERVENTIONS Patients were r and omly assigned to receive oxygen therapy alone ( n = 61 ) or oxygen therapy plus CPAP ( n = 62 ) . MAIN OUTCOME MEASURES Improvement in PaO(2)/FIO(2 ) ratio , rate of endotracheal intubation at any time during the study , adverse events , length of hospital stay , mortality , and duration of ventilatory assistance , compared between the CPAP and st and ard treatment groups . RESULTS Among the CPAP vs st and ard therapy groups , respectively , causes of respiratory failure ( pneumonia , 54 % and 55 % ) , presence of cardiac disease ( 33 % and 35 % ) , severity at admission , and hypoxemia ( median [ 5th-95th percentile ] PaO(2)/FIO(2 ) ratio , 140 [ 59 - 288 ] mm Hg vs 148 [ 62 - 283 ] mm Hg ; P = .43 ) were similarly distributed . After 1 hour of treatment , subjective responses to treatment ( P<.001 ) and median ( 5th-95th percentile ) PaO(2)/FIO(2 ) ratios were greater with CPAP ( 203 [ 45 - 431 ] mm Hg vs 151 [ 73 - 482 ] mm Hg ; P = .02 ) . No further difference in respiratory indices was observed between the groups . Treatment with CPAP failed to reduce the endotracheal intubation rate ( 21 [ 34 % ] vs 24 [ 39 % ] in the st and ard therapy group ; P = .53 ) , hospital mortality ( 19 [ 31 % ] vs 18 [ 30 % ] ; P = .89 ) , or median ( 5th-95th percentile ) intensive care unit length of stay ( 6.5 [ 1 - 57 ] days vs 6.0 [ 1 - 36 ] days ; P = .43 ) . A higher number of adverse events occurred with CPAP treatment ( 18 vs 6 ; P = .01 ) . CONCLUSION In this study , despite early physiologic improvement , CPAP neither reduced the need for intubation nor improved outcomes in patients with acute hypoxemic , nonhypercapnic respiratory insufficiency primarily due to acute lung injury . JAMA . 2000;284:2352 - 2360 Objective Noninvasive ventilation ( NIV ) fails more frequently for de novo acute respiratory failure ( de novo ) than for cardiogenic pulmonary edema ( CPE ) or acute-on-chronic respiratory failure ( AOC ) . The impact of NIV failure and success was compared between de novo and CPE or AOC after adjustment for disease severity . Setting s Patients requiring ventilatory support were enrolled in a prospect i ve survey in 70 French ICUs . Of 1076 patients requiring ventilatory support , 524 were eligible , including 299 de novo ( NIV use , 30 % ) and 225 CPE-AOC ( NIV use , 55 % ) . Design and analysis Independent risk factors associated with mortality and length of stay were identified by logistic regression analysis . The adjusted outcome of NIV success or failure was compared to that with endotracheal intubation without NIV . Results  NIV success was independently associated with survival in both de novo , adjusted OR 0.05 ( 95 % CI 0.01–0.42 ) , and CPE-AOC OR 0.03 ( CI 0.01–0.24 ) . NIV failure was associated with ICU mortality in the de novo group ( OR 3.24 , CI 1.61–6.53 ) but not in the CPE-AOC group . Nosocomial pneumonia was less common in patients successful with NIV .  NIV failure was associated with a longer ICU stay in CPE-AOC only . The overall use of NIV was independently associated with a better outcome only in CPE-AOC patients ( OR 0.33 , CI 0.15–0.73 ) . Conclusion The effect of NIV differs between de novo and CPE-AOC patients because NIV failure is associated with increased mortality for de novo patients . This finding should raise a note of caution when applying NIV in this indication Objective . To compare noninvasive positive pressure ventilation ( NPPV ) vs. invasive mechanical ventilation in AIDS patients with Pneumocystis carinii pneumonia (PCP)-related acute respiratory failure ( ARF ) . Design : A single-center , prospect i ve , case-control trial . Setting : An ICU of a private tertiary hospital specialized in infectious disease . Patients : Forty-eight AIDS patients with severe PCP-related ARF needing mechanical ventilation . Interventions : Twenty-four patients treated with NPPV by a facial mask strictly matched with 24 patients treated with invasive ventilation by endotracheal intubation . Results : Use of NPPV  avoided intubation in 67 % of patients , and avoidance of intubation was associated with improved survival ( 100 % vs. 38 % ; P=0.003 ) . NPPV-treated patients required fewer invasive devices ( P<0.001 ) and had a lower incidence of pneumothoraces ( 8.3 % vs. 37.5 % ; P=0.039 ) . The NPPV-treated group required a nurse workload similar to that of the conventional ventilation group , but this group had a shorter duration of stay in the ICU ( P=0.013 ) . The NPPV-treated group had a lower mortality in the ICU , the hospital and within 2 months of study entry . Differences in mortality between the two groups disappeared after 6 months . Conclusions : The findings of this study seem to provide further support for applying NPPV in AIDS patients with severe PCP-related ARF as a first-line therapeutic choice , but r and omized controlled trials are required to confirm our results CONTEXT Noninvasive ventilation ( NIV ) has been associated with lower rates of endotracheal intubation in population s of patients with acute respiratory failure . OBJECTIVE To compare NIV with st and ard treatment using supplemental oxygen administration to avoid endotracheal intubation in recipients of solid organ transplantation with acute hypoxemic respiratory failure . DESIGN AND SETTING Prospect i ve r and omized study conducted at a 14-bed , general intensive care unit of a university hospital . PATIENTS Of 238 patients who underwent solid organ transplantation from December 1995 to October 1997 , 51 were treated for acute respiratory failure . Of these , 40 were eligible and 20 were r and omized to each group . INTERVENTION Noninvasive ventilation vs st and ard treatment with supplemental oxygen administration . MAIN OUTCOME MEASURES The need for endotracheal intubation and mechanical ventilation at any time during the study , complications not present on admission , duration of ventilatory assistance , length of hospital stay , and intensive care unit mortality . RESULTS The 2 groups were similar at study entry . Within the first hour of treatment , 14 patients ( 70 % ) in the NIV group , and 5 patients ( 25 % ) in the st and ard treatment group improved their ratio of the PaO2 to the fraction of inspired oxygen ( FIO2 ) . Over time , a sustained improvement in PaO2 to FIO2 was noted in 12 patients ( 60 % ) in the NIV group , and in 5 patients ( 25 % ) r and omized to st and ard treatment ( P = .03 ) . The use of NIV was associated with a significant reduction in the rate of endotracheal intubation ( 20 % vs 70 % ; P = .002 ) , rate of fatal complications ( 20 % vs 50 % ; P = .05 ) , length of stay in the intensive care unit by survivors ( mean [ SD ] days , 5.5 [ 3 ] vs 9 [ 4 ] ; P = .03 ) , and intensive care unit mortality ( 20 % vs 50 % ; P = .05 ) . Hospital mortality did not differ . CONCLUSIONS These results indicate that transplantation programs should consider NIV in the treatment of selected recipients of transplantation with acute respiratory failure When treated with invasive endotracheal mechanical ventilation ( ETMV ) , acute respiratory insufficiency after lung resection is fatal in up to 80 % of cases . Noninvasive positive-pressure ventilation ( NPPV ) may reduce the need for ETMV , thereby improving survival . We conducted a r and omized prospect i ve trial to compare st and ard therapy with and without nasal-mask NPPV in patients with acute hypoxemic respiratory insufficiency after lung resection . The primary outcome variable was the need for ETMV and the secondary outcome variables were in-hospital and 120-d mortality rates , duration of stay in the intensive care unit , and duration of in-hospital stay . Twelve of the 24 patients ( 50 % ) r and omly assigned to the no-NPPV group required ETMV , versus only five of the 24 patients ( 20.8 % ) in the NPPV group ( p = 0.035 ) . Nine patients in the no-NPPV group died ( 37.5 % ) , and three ( 12.5 % ) patients in the NPPV group died ( p = 0.045 ) . The other secondary outcomes were similar in the two groups . NPPV is safe and effective in reducing the need for ETMV and improving survival after lung resection Abstract Objectives A prospect i ve survey of French intensive care units ( ICUs ) in 1997 showed moderate and variable use of noninvasive ventilation ( NIV ) . This study examined changes in NIV use in French ICUs after the intervening 5 years . Setting s Patients were enrolled in a prospect i ve survey in 70 French ICUs . Methods Three-week survey , with prospect i ve inclusion of all patients requiring  ventilatory support . Measurements and results Overall 1,076 patients received  ventilatory support  ( 55 % of admissions ) .  First-line NIV  was significantly more common than 5 years earlier , overall ( 23 % vs. 16 % ) and especially in patients not intubated before ICU admission ( 52 % vs. 35 % ) . Reasons for respiratory failure were coma ( 33 % ) , cardiogenic pulmonary edema ( 8 % ) , acute-on-chronic respiratory failure ( 17 % ) , and de novo respiratory failure ( 41 % ) . Significant increases in  NIV use were noted for acute-on-chronic respiratory failure ( 64 % vs. 50 % ) and de novo respiratory failure ( 22 % vs. 14 % ) . Among patients given NIV , 38 % subsequently required endotracheal intubation ( not 
    Output:
    
agent
***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: Objective To compare the physiological effects and the clinical efficacy of continuous positive airway pressure ( CPAP ) vs st and ard medical treatment in elderly patients ( ≥75 years ) with acute hypoxemic respiratory failure related to cardiogenic pulmonary edema . Design A prospect i ve , r and omized , concealed , and unblinded study of 89 consecutive patients who were admitted to the emergency departments of one general , and three teaching , hospitals . Intervention Patients were r and omly assigned to receive st and ard medical treatment alone ( n=46 ) or st and ard medical treatment plus CPAP ( n=43 ) . Measurements Improvement in PaO2/FIO2 ratio , complications , length of hospital stay , early 48-h and overall mortality , compared between the CPAP and st and ard treatment groups . Results Study groups were comparable with regard to baseline physiological and clinical characteristics ( age , sex ratio , autonomy , medical history , cause of pulmonary edema ) . Within 1 h , noninvasive continuous positive airway pressure led to decreased respiratory rate ( respiratory rate , 27±7 vs 35±6 breaths/min ; p=0.009 ) , and improved oxygenation ( PaO2/FIO2 , 306±104 vs 157±71 ; p=0.004 ) compared with baseline , whereas no differences were observed within the st and ard treatment group . Severe complications occurred in 17 patients in the st and ard treatment group , vs 4 patients in the noninvasive continuous positive airway pressure group ( p=0.002 ) . Early 48-h mortality was 7 % in the noninvasive continuous positive airway pressure group , compared with 24 % in the st and ard treatment group ( p=0.017 ) ; however , no sustained benefits were observed during the overall hospital stay . Conclusion Noninvasive continuous positive airway pressure promotes early clinical improvement in elderly patients attending emergency departments for a severe pulmonary edema , but only reduces early 48-h mortality CONTEXT Continuous positive airway pressure ( CPAP ) is widely used in the belief that it may reduce the need for intubation and mechanical ventilation in patients with acute hypoxemic respiratory insufficiency . OBJECTIVE To compare the physiologic effects and the clinical efficacy of CPAP vs st and ard oxygen therapy in patients with acute hypoxemic , nonhypercapnic respiratory insufficiency . DESIGN , SETTING , AND PATIENTS R and omized , concealed , and unblinded trial of 123 consecutive adult patients who were admitted to 6 intensive care units between September 1997 and January 1999 with a PaO(2)/FIO(2 ) ratio of 300 mm Hg or less due to bilateral pulmonary edema ( n = 102 with acute lung injury and n = 21 with cardiac disease ) . INTERVENTIONS Patients were r and omly assigned to receive oxygen therapy alone ( n = 61 ) or oxygen therapy plus CPAP ( n = 62 ) . MAIN OUTCOME MEASURES Improvement in PaO(2)/FIO(2 ) ratio , rate of endotracheal intubation at any time during the study , adverse events , length of hospital stay , mortality , and duration of ventilatory assistance , compared between the CPAP and st and ard treatment groups . RESULTS Among the CPAP vs st and ard therapy groups , respectively , causes of respiratory failure ( pneumonia , 54 % and 55 % ) , presence of cardiac disease ( 33 % and 35 % ) , severity at admission , and hypoxemia ( median [ 5th-95th percentile ] PaO(2)/FIO(2 ) ratio , 140 [ 59 - 288 ] mm Hg vs 148 [ 62 - 283 ] mm Hg ; P = .43 ) were similarly distributed . After 1 hour of treatment , subjective responses to treatment ( P<.001 ) and median ( 5th-95th percentile ) PaO(2)/FIO(2 ) ratios were greater with CPAP ( 203 [ 45 - 431 ] mm Hg vs 151 [ 73 - 482 ] mm Hg ; P = .02 ) . No further difference in respiratory indices was observed between the groups . Treatment with CPAP failed to reduce the endotracheal intubation rate ( 21 [ 34 % ] vs 24 [ 39 % ] in the st and ard therapy group ; P = .53 ) , hospital mortality ( 19 [ 31 % ] vs 18 [ 30 % ] ; P = .89 ) , or median ( 5th-95th percentile ) intensive care unit length of stay ( 6.5 [ 1 - 57 ] days vs 6.0 [ 1 - 36 ] days ; P = .43 ) . A higher number of adverse events occurred with CPAP treatment ( 18 vs 6 ; P = .01 ) . CONCLUSION In this study , despite early physiologic improvement , CPAP neither reduced the need for intubation nor improved outcomes in patients with acute hypoxemic , nonhypercapnic respiratory insufficiency primarily due to acute lung injury . JAMA . 2000;284:2352 - 2360 Objective Noninvasive ventilation ( NIV ) fails more frequently for de novo acute respiratory failure ( de novo ) than for cardiogenic pulmonary edema ( CPE ) or acute-on-chronic respiratory failure ( AOC ) . The impact of NIV failure and success was compared between de novo and CPE or AOC after adjustment for disease severity . Setting s Patients requiring ventilatory support were enrolled in a prospect i ve survey in 70 French ICUs . Of 1076 patients requiring ventilatory support , 524 were eligible , including 299 de novo ( NIV use , 30 % ) and 225 CPE-AOC ( NIV use , 55 % ) . Design and analysis Independent risk factors associated with mortality and length of stay were identified by logistic regression analysis . The adjusted outcome of NIV success or failure was compared to that with endotracheal intubation without NIV . Results  NIV success was independently associated with survival in both de novo , adjusted OR 0.05 ( 95 % CI 0.01–0.42 ) , and CPE-AOC OR 0.03 ( CI 0.01–0.24 ) . NIV failure was associated with ICU mortality in the de novo group ( OR 3.24 , CI 1.61–6.53 ) but not in the CPE-AOC group . Nosocomial pneumonia was less common in patients successful with NIV .  NIV failure was associated with a longer ICU stay in CPE-AOC only . The overall use of NIV was independently associated with a better outcome only in CPE-AOC patients ( OR 0.33 , CI 0.15–0.73 ) . Conclusion The effect of NIV differs between de novo and CPE-AOC patients because NIV failure is associated with increased mortality for de novo patients . This finding should raise a note of caution when applying NIV in this indication Objective . To compare noninvasive positive pressure ventilation ( NPPV ) vs. invasive mechanical ventilation in AIDS patients with Pneumocystis carinii pneumonia (PCP)-related acute respiratory failure ( ARF ) . Design : A single-center , prospect i ve , case-control trial . Setting : An ICU of a private tertiary hospital specialized in infectious disease . Patients : Forty-eight AIDS patients with severe PCP-related ARF needing mechanical ventilation . Interventions : Twenty-four patients treated with NPPV by a facial mask strictly matched with 24 patients treated with invasive ventilation by endotracheal intubation . Results : Use of NPPV  avoided intubation in 67 % of patients , and avoidance of intubation was associated with improved survival ( 100 % vs. 38 % ; P=0.003 ) . NPPV-treated patients required fewer invasive devices ( P<0.001 ) and had a lower incidence of pneumothoraces ( 8.3 % vs. 37.5 % ; P=0.039 ) . The NPPV-treated group required a nurse workload similar to that of the conventional ventilation group , but this group had a shorter duration of stay in the ICU ( P=0.013 ) . The NPPV-treated group had a lower mortality in the ICU , the hospital and within 2 months of study entry . Differences in mortality between the two groups disappeared after 6 months . Conclusions : The findings of this study seem to provide further support for applying NPPV in AIDS patients with severe PCP-related ARF as a first-line therapeutic choice , but r and omized controlled trials are required to confirm our results CONTEXT Noninvasive ventilation ( NIV ) has been associated with lower rates of endotracheal intubation in population s of patients with acute respiratory failure . OBJECTIVE To compare NIV with st and ard treatment using supplemental oxygen administration to avoid endotracheal intubation in recipients of solid organ transplantation with acute hypoxemic respiratory failure . DESIGN AND SETTING Prospect i ve r and omized study conducted at a 14-bed , general intensive care unit of a university hospital . PATIENTS Of 238 patients who underwent solid organ transplantation from December 1995 to October 1997 , 51 were treated for acute respiratory failure . Of these , 40 were eligible and 20 were r and omized to each group . INTERVENTION Noninvasive ventilation vs st and ard treatment with supplemental oxygen administration . MAIN OUTCOME MEASURES The need for endotracheal intubation and mechanical ventilation at any time during the study , complications not present on admission , duration of ventilatory assistance , length of hospital stay , and intensive care unit mortality . RESULTS The 2 groups were similar at study entry . Within the first hour of treatment , 14 patients ( 70 % ) in the NIV group , and 5 patients ( 25 % ) in the st and ard treatment group improved their ratio of the PaO2 to the fraction of inspired oxygen ( FIO2 ) . Over time , a sustained improvement in PaO2 to FIO2 was noted in 12 patients ( 60 % ) in the NIV group , and in 5 patients ( 25 % ) r and omized to st and ard treatment ( P = .03 ) . The use of NIV was associated with a significant reduction in the rate of endotracheal intubation ( 20 % vs 70 % ; P = .002 ) , rate of fatal complications ( 20 % vs 50 % ; P = .05 ) , length of stay in the intensive care unit by survivors ( mean [ SD ] days , 5.5 [ 3 ] vs 9 [ 4 ] ; P = .03 ) , and intensive care unit mortality ( 20 % vs 50 % ; P = .05 ) . Hospital mortality did not differ . CONCLUSIONS These results indicate that transplantation programs should consider NIV in the treatment of selected recipients of transplantation with acute respiratory failure When treated with invasive endotracheal mechanical ventilation ( ETMV ) , acute respiratory insufficiency after lung resection is fatal in up to 80 % of cases . Noninvasive positive-pressure ventilation ( NPPV ) may reduce the need for ETMV , thereby improving survival . We conducted a r and omized prospect i ve trial to compare st and ard therapy with and without nasal-mask NPPV in patients with acute hypoxemic respiratory insufficiency after lung resection . The primary outcome variable was the need for ETMV and the secondary outcome variables were in-hospital and 120-d mortality rates , duration of stay in the intensive care unit , and duration of in-hospital stay . Twelve of the 24 patients ( 50 % ) r and omly assigned to the no-NPPV group required ETMV , versus only five of the 24 patients ( 20.8 % ) in the NPPV group ( p = 0.035 ) . Nine patients in the no-NPPV group died ( 37.5 % ) , and three ( 12.5 % ) patients in the NPPV group died ( p = 0.045 ) . The other secondary outcomes were similar in the two groups . NPPV is safe and effective in reducing the need for ETMV and improving survival after lung resection Abstract Objectives A prospect i ve survey of French intensive care units ( ICUs ) in 1997 showed moderate and variable use of noninvasive ventilation ( NIV ) . This study examined changes in NIV use in French ICUs after the intervening 5 years . Setting s Patients were enrolled in a prospect i ve survey in 70 French ICUs . Methods Three-week survey , with prospect i ve inclusion of all patients requiring  ventilatory support . Measurements and results Overall 1,076 patients received  ventilatory support  ( 55 % of admissions ) .  First-line NIV  was significantly more common than 5 years earlier , overall ( 23 % vs. 16 % ) and especially in patients not intubated before ICU admission ( 52 % vs. 35 % ) . Reasons for respiratory failure were coma ( 33 % ) , cardiogenic pulmonary edema ( 8 % ) , acute-on-chronic respiratory failure ( 17 % ) , and de novo respiratory failure ( 41 % ) . Significant increases in  NIV use were noted for acute-on-chronic respiratory failure ( 64 % vs. 50 % ) and de novo respiratory failure ( 22 % vs. 14 % ) . Among patients given NIV , 38 % subsequently required endotracheal intubation ( not 
    Output:
    