In response to the comments by Drs. Mehta and Groth, the
observation that survivors had a mean duration of hospital stay of 0.8
days before receiving mechanical ventilation, compared with 2.8 days
for nonsurvivors, could be taken to imply that earlier initiation of
mechanical ventilation at the first sign of significant respiratory
failure in community-acquired pneumonia (CAP) could favorably impact
prognosis. In addition to the finding above, our observation, that the
hypoxemia index was lower in survivors vs nonsurvivors (37 vs 59,
respectively)1 over the first 24 h of mechanical
ventilation, supports one of the following: (1) that survivors were
intubated earlier in the course of their respiratory failure, as Drs.
Mehta and Groth have suggested; or (2) that overall, survivors had less
severe lung injury as a group, independent of the timing of intubation.
Because this was a retrospective study, it is difficult to determine
which of these two factors was more dominant. Based on our data,
therefore, we cannot make the claim that earlier treatment with
intubation and/or mechanical ventilation for respiratory failure
ultimately leads to a more favorable prognosis in patients with CAP.