Early non‐invasive ventilation treatment for respiratory failure due to severe community‐acquired pneumonia

Clinical Respiratory Journal - Tập 10 Số 1 - Trang 98-103 - 2016
Antonello Nicolini1, Gianluca Ferraioli2, Maura Ferrari‐Bravo3, Cornelius Barlascini4, Mario Santo5, Lorenzo Ferrera6
1Respiratory Diseases Unit, ASL4 Chiavarese, Sestri Levante, Italy.
2Emergency Medicine Unit, ASL4 Chiavarese, Lavagna, Italy.
3Public Health Unit, ASL4 Chiavarese, Chiavari, Italy.
4Forensic Medicine, ASL4 Chiavarese, Chiavari, Italy.
5Respiratory Diseases Unit, Umberto Parini Hospital, Aosta, Italy.
6Respiratory Diseases Unit, Villa Scassi Hospital, Genova, Italy.

Tóm tắt

AbstractBackground and AimsSevere 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.MethodsWe prospectively assessed 127 patients with sCAP and severe acute respiratory failure [oxygen arterial pressure/oxygen inspiratory fraction ratio (PaO2/FiO2) <250]. We defined successful NIV as avoidance of intubation and the achievement of PaO2/FiO2 >250 with spontaneous breathing. We assessed predictors of NIV failure and hospital mortality using univariate and multivariate analyses.ResultsNIV 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.ConclusionsSuccessful 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.

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Tài liệu tham khảo

10.1016/j.idc.2009.04.003

10.1007/s00134-012-2475-6

Nicolini A, 2012, Effectiveness and predictors of success of non‐invasive ventilation during H1N1 pandemics: a multi center study, Minerva Anestesiol, 78, 1332

10.1007/s00134-001-1114-4

10.1016/j.jcrc.2010.02.012

10.1016/S0873-2159(15)31253-8

10.1111/j.1469-0691.2012.03797.x

10.1097/IPC.0b013e31828264d8

10.1378/chest.127.3.952

Lim WS, 2009, BTS guidelines for the management of community acquired pneumonia in adults: update 2009, Thorax, 64, 1

Opravil M, 1994, Shortcomings of chest radiographs in detecting Pneumocystis carinii pneumonia, J Acquir Immune Defic Syndr, 7, 39

10.1164/ajrccm.160.5.9903015

10.1007/s00134-006-0324-1

10.1164/rccm.200301-072OC

Ugcun I, 2010, The efficacy of non‐invasive positive ventilation in ARDS: a controlled cohort study, Tuberk Toraks, 58, 16

10.1378/chest.09-1547

10.1186/1756-0500-4-375

10.1378/chest.07-1456

10.1378/chest.08-0280

10.1016/j.ejim.2011.11.002

10.1097/CPM.0b013e31820e6f39

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Thông tin xuất bản

Clinical Respiratory Journal

Tập 10 Số 1

98-103

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