Respiratory Care |

Effectiveness of Early Noninvasive Ventilation Treatment for SevereRespiratory Failure Due to Community Acquired Pneumonia FREE TO VIEW

Antonello Nicolini, MD
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Internal Medicine, Respiratory Diseases Unit, Sestri Levante, Italy

Chest. 2014;146(4_MeetingAbstracts):908A. doi:10.1378/chest.1961251
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SESSION TITLE: Non-Ventilatory Respiratory Support

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Monday, October 27, 2014 at 04:30 PM - 05:30 PM

PURPOSE: Severe community-acquired pneumonia ( CAP) have beendefined pneumonia requiring admission to the intensive care unit and use ofinvasive ventilation.The use of invasive ventilation can cause severalcomplications,as the admission to ICU.For this reason non-invasive ventilation(NIV) has been used to avoid andotracheal intubation.However,few studies havecurrently assessed definitively the usefulness of NIV in patients with CAP andsevere acute respiratory failure (ARF). An observational perspective study toassess the safety of NIV and predictors of NIV failure and hospital mortalitywas performed.

METHODS: We prospectively enrolled 65 patients with CAP and severeARF (paO2/FiO2<250);28 had "de novo" ARF and 37 previous cardiac andrespiratory disease.We defined successful NIV as avoidance of intubation and theachievement of PaO2/FiO2 >250 with spontaneous breathing.

RESULTS: NIV failed in 13 patients (20.0%) with a similar rate inpatients with "de novo" ARF and previous cardiac or respiratory disease(5/28)[17.8%] versus 8/37 [21.6%].Higher chest X-ray score at admission,higherheart rate after 1 h of NIV and a higher alveolar-arteriolar gradient ( A-aDO2)after 24 h of NIV independently predicted NIV failure.Higher chest X-rayscore,higher LDH at admission,higher heart rate and A-aDO2 after 24 h of NIVwere strictly related to hospital mortality

CONCLUSIONS: Successful treatment is strongly related to lessextension of the lung involvement and to a good initial and long-lastingresponse to the medical and NIV treatment

CLINICAL IMPLICATIONS: Our finding suggest that physician shouldconsider the use of NIV (when appropriate) for hospitalized patients with severepneumonia

DISCLOSURE: The following authors have nothing to disclose:Antonello Nicolini

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