Randomized trials vs. clinical reality

October 16, 2000

The use of noninvasive positive-pressure ventilation (NIPPV) instead of intubation in cases of acute respiratory failure has become more widespread over the past decade, but its use and outcomes in the clinical setting are uncertain. Dr. Tasnim Sinuff and colleagues reviewed the records of consecutive patients treated with over 15 months in a Canadian teaching hospital in an attempt to answer these questions.

While NIPPV has been shown to decrease mortality and the need for endotrachial intubation in patients with respiratory failure, Sinuff and colleagues found that mortality was 28.6% higher in their observed clinical setting than in randomized trials. They report that many factors likely contributed to this difference, including the experience and training level of the physician initiating the treatment. They recommend the development of a multidisciplinary educational practice guideline as a method to optimize the use of NIPPV.
In a related commentary, Dr. Sheldon Magder addresses the pitfalls of leaning to heavily on the findings of randomized trials in a clinical setting.

Noninvasive positive-pressure ventilation: a utilization review of use in a teaching hospital -- T. Sinuff, D. Cook, J. Randall, C. Allen

Dr. Deborah Cook, of the Department of Medicine, St. Joseph's Hospital in Hamilton, Ont. is available for comment at 905 525-9140 x22555

The limitations of evidence from randomized trials -- S. Magder Dr. Sheldon Magder, of the Critical Care Division of the Royal Victoria Hospital in Montreal is available for comment at 514 843-1664

Contact: Dr. Tasnim Sinuff, Departments of Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ont. tel 905 Dr. Sheldon Magder, Critical Care Division, Royal Victoria Hospital, Montreal; tel 514

Canadian Medical Association Journal

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