Open AccessEarly non‐invasive ventilation treatment for respiratory failure due to severe community‐acquired pneumonia
Author(s) -
Nicolini Antonello,
Ferraioli Gianluca,
FerrariBravo Maura,
Barlascini Cornelius,
Santo Mario,
Ferrera Lorenzo
Publication year - 2016
Publication title -
the clinical respiratory journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.789
H-Index - 33
eISSN - 1752-699X
pISSN - 1752-6981
DOI - 10.1111/crj.12184
Subject(s) - medicine , respiratory failure , pneumonia , ventilation (architecture) , fraction of inspired oxygen , anesthesia , intensive care unit , respiratory rate , intubation , mechanical ventilation , arterial blood , intensive care medicine , blood pressure , heart rate , mechanical engineering , engineering
Background and Aims Severe community‐acquired pneumonia (s CAP ) have been as defined pneumonia requiring admission to the intensive care unit or carrying a high risk of death. Currently, the treatment of s CAP consists of antibiotic therapy and ventilator support. The use of invasive ventilation causes several complications as does admission to ICU . For this reason, non‐invasive ventilation ( NIV ) has been used for acute respiratory failure to avoid endotracheal intubation. However, few studies have currently assessed the usefulness of NIV in s CAP . Methods We prospectively assessed 127 patients with s CAP and severe acute respiratory failure [oxygen arterial pressure/oxygen inspiratory fraction ratio ( P a O 2 / F i O 2 ) <250]. We defined successful NIV as avoidance of intubation and the achievement of P a O 2 / F i O 2 >250 with spontaneous breathing. We assessed predictors of NIV failure and hospital mortality using univariate and multivariate analyses. Results NIV failed in 32 patients (25.1%). Higher chest X ‐ray score at admission, chest X ‐ray worsening, and a lower P a O 2 /F i O 2 and higher alveolar‐arteriolar gradient ( A ‐a DO 2 ) after 1 h of NIV all independently predicted NIV failure. Higher lactate dehydrogenase and confusion, elevated blood urea, respiratory rate, blood pressure plus age ≥65 years at admission, higher A ‐a DO 2 , respiratory rate and lower P a O 2 / FiO 2 after 1 h of NIV and intubation rate were directly related to hospital mortality. Conclusions Successful treatment is strongly related to less severe illness as well as to a good initial and sustained response to medical therapy and NIV treatment. Constant monitoring of these patients is mandatory.