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Editorials 4. Delclaux C, L’Her E, Alberti C, et al: Treatment of acute hypoxemic nonhypercapnic respiratory insufficiency with continuous positive air- way pressure delivered by a face mask: A randomized controlled trial. JAMA 2000; 284:2352–2360 5. Demoule A, Girou E, Richard JC, et al: Benefits and risks of suc- cess or failure of noninvasive ventilation. Intensive Care Med 2006; 6. Esteban A, Frutos-Vivar F, Muriel A, et al: Evolution of mortality over time in patients receiving mechanical ventilation. Am J Respir Crit Care Med 2013; 188:220–230 7. Frat JP, Thille AW, Mercat A, et al; FLORALI Study Group; REVA Network: High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure. N Engl J Med 2015; 372:2185–2196 8. Carteaux G, Millan-Guilarte T, De Prost N, et al: Failure of Noninvasive Ventilation for De Novo Acute Hypoxemic Respiratory Failure: Role of Tidal Volume. Crit Care Med 2016; 44:282–290 9. L’Her E, Deye N, Lellouche F, et al: Physiologic effects of noninvasive ventilation during acute lung injury. Am J Respir Crit Care Med 2005; 10. Dreyfuss D, Saumon G: Ventilator-induced lung injury: Lessons from experimental studies. Am J Respir Crit Care Med 1998; 11. Jiang TX, Reid WD, Belcastro A, et al: Load dependence of second- ary diaphragm inflammation and injury after acute inspiratory loading. Am J Respir Crit Care Med 1998; 157:230–236 12. Vassilakopoulos T, Divangahi M, Rallis G, et al: Differential cytokine gene expression in the diaphragm in response to strenuous resistive breathing. Am J Respir Crit Care Med 2004; 170:154–161 13. Toumpanakis D, Kastis GA, Zacharatos P, et al: Inspiratory resistive breathing induces acute lung injury. Am J Respir Crit Care Med Improved Outcomes in Critically Ill Patients With AIDS: How Does This Trend Continue?* “Success needs no explanation. Failure does not have one that matters.” –Jesse Jackson Daniel A. Sweeney, MD Division of Pulmonary, Critical Care and Sleep Medicine University of California, San Diego La Jolla, CA Kevan Akrami, MD Division of Infectious Diseases University of California, San Diego La Jolla, CA; and Critical Care Medicine Department Clinical Center National Institutes of Health Bethesda, MD Atul Malhotra, MD Division of Pulmonary, Critical Care and Sleep Medicine University of California, San Diego La Jolla, CA I n this issue of Critical Care Medicine, Huson et al (1) thoughtfully describe the clinical characteristics and out- comes of patients with AIDS admitted to Dutch ICUs *See also p. 291. Key Words: acquired immunodeficiency syndrome; antiretroviral therapy; intensive care; mortality; noninvasive ventilation Dr. Malhotra received support for article research from the National Insti- tutes of Health (NIH). The remaining authors have disclosed that they do not have any potential conflicts of interest. The opinions expressed in this article are the authors’ own and do not represent any position or policy of the NIH, the Department of Health and Human Services, or the U.S. government. Copyright © 2016 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved. DOI: 10.1097/CCM.1492 www.ccmjournal.org during the era of combination antiretroviral therapy (cART) from 1997 to 2014. Their findings show that major progress has been made during this time period such that patients with AIDS being treated in ICUs now have mortality rates approach- ing that of patients without AIDS. Although it could be argued that this success story needs no explanation, the true impact of this study may lie with the questions it raises. This study chal- lenges care providers to search for the treatment modifications that may explain this trend so as to promote further improve- ment in the care of critically ill patients with AIDS. Huson et al (1) performed a retrospective analysis of 1,127 AIDS patients and 4,479 controls (non-AIDS patients matched for age, sex, and admission type [medical or surgical and planned or unplanned]) treated in Dutch ICUs from 1997 to 2014. In general, AIDS patients had significantly more comorbidities, were more acutely ill based on Acute Physiology and Chronic Health Evalu- ation (APACHE) II scores, and were more likely to be admitted with another infection—typically a respiratory infection or sepsis. Not surprisingly, AIDS patients experienced a higher overall mor- tality rate than controls (28.2% vs 17.8%; p u003c 0.0001). More interesting and encouraging than these data are the favorable trends that were identified in critically ill AIDS patients from 1999 to 2014. Although the mortality rate for both AIDS and non-AIDS patients declined over the study period (39–16% and 22–14%, respectively), the aver- age annual percentage change was greater for patients with AIDS than controls (–6.0 [–8.0 to –3.9] vs –2.1 [–4.1 to –0.1]; p = 0.02). This greater decline in mortality among AIDS patients coincided with a downward trend in the proportion of AIDS patients being admitted with a respiratory infection. Further anal- yses suggest that decline in mortality was largely a function of the improved outcome in the subset of AIDS patients admitted with an infectious diagnosis. Using standardized mortality rates to control February 2016 • Volume 44 • Number 2 Copyright © 2016 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.