Early non-invasive ventilation treatment for respiratory failure due to severe community-acquired pneumonia
| Autor: | Mario Santo, Lorenzo Ferrera, Cornelius Barlascini, Antonello Nicolini, Gianluca Ferraioli, Maura Ferrari-Bravo |
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| Rok vydání: | 2014 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty Respiratory rate business.industry medicine.medical_treatment medicine.disease Intensive care unit law.invention 03 medical and health sciences Pneumonia 0302 clinical medicine Blood pressure 030228 respiratory system Community-acquired pneumonia Respiratory failure law Anesthesia medicine Breathing Immunology and Allergy Intubation 030212 general & internal medicine Intensive care medicine business Genetics (clinical) |
| Zdroj: | The Clinical Respiratory Journal. 10:98-103 |
| ISSN: | 1752-6981 |
| DOI: | 10.1111/crj.12184 |
| Popis: | Background and Aims Severe community-acquired pneumonia (sCAP) have been as defined pneumonia requiring admission to the intensive care unit or carrying a high risk of death. Currently, the treatment of sCAP 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 sCAP. Methods We prospectively assessed 127 patients with sCAP and severe acute respiratory failure [oxygen arterial pressure/oxygen inspiratory fraction ratio (PaO2/FiO2) 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 PaO2/FiO2 and higher alveolar-arteriolar gradient (A-aDO2) 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-aDO2, respiratory rate and lower PaO2/FiO2 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. |
| Databáze: | OpenAIRE |
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