Highlights
- •In pneumonia, CPAP was used mainly for non-hypercapnic ARF, NPPV for hypercapnic ARF.
- •Mortality was associated to patients' basal status rather than baseline degree of ARF.
- •Intolerance was responsible of clinical failure and death in only 5/60 cases (8%).
- •When CPAP failed, NPPV had a role as rescue treatment (56% survived after switch).
Abstract
Background and objective
Non-Invasive Ventilation (NIV) represents a standard of care to treat some acute respiratory
failure (ARF). Data on its use in pneumonia are lacking, especially in a setting outside
the Intensive Care Unit (ICU). The aims of this study were to evaluate the use of
NIV in ARF due to pneumonia outside the ICU, and to identify risk factors for in-hospital
mortality.
Methods
Prospective, observational study performed in 19 centers in Italy. Patients with ARF
due to pneumonia treated outside the ICU with either continuous positive airway pressure
(CPAP) or noninvasive positive pressure ventilation (NPPV) were enrolled over a period
of at least 3 consecutive months in 2013. Independent factors related to in-hospital
mortality were evaluated.
Results
Among the 347 patients enrolled, CPAP was applied as first treatment in 176 (50.7%)
patients,NPPV in 171 (49.3%). The NPPV compared with CPAP group showed a significant
higher PaCO2 (55 [47–78] vs 37 [32–43] mmHg, p < 0.001), a lower arterial pH (7.30 [7.21–7.37]
vs 7.43 [7.35–7.47], p < 0.001), higher HCO3– (28 [24–33] vs 24 [21–27] mmol/L, p < 0.001).
De-novo ARF was more prevalent in CPAP group than in NPPV group (86/176 vs 31/171 patients,p < 0.001).
In-hospital mortality was 23% (83/347). Do Not Intubate (DNI) order and Charlson Comorbidity
Index (CCI) ≥3 were independent risk factors for in-hospital mortality.
Conclusions
Outside ICU setting, CPAP was used mainly for hypoxemic non-hypercapnic ARF, NPPV
for hypercapnic ARF. In-hospital mortality was mainly associated to patients' basal
status (DNI status, CCI) rather than the baseline degree of ARF.
Keywords
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Article info
Publication history
Published online: October 24, 2018
Accepted:
September 28,
2018
Received in revised form:
September 26,
2018
Received:
August 19,
2018
Identification
Copyright
© 2018 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
