Utilization Trends and Predictors of Non-invasive and Invasive Ventilation During Hospitalization Due to Community-Acquired Pneumonia

Cureus ◽  
2021 ◽  
Harshil Shah ◽  
Jude ElSaygh ◽  
Abdur Raheem ◽  
Mohammed A Yousuf ◽  
Lac Han Nguyen ◽  
2019 ◽  
Vol 7 (1) ◽  
pp. 10 ◽  
Nicolò Maria Vanoni ◽  
Manuela Carugati ◽  
Noemi Borsa ◽  
Giovanni Sotgiu ◽  
Laura Saderi ◽  

Community-acquired pneumonia (CAP) is a leading cause of mortality worldwide. CAP mortality is driven by the development of sepsis and acute respiratory failure (ARF). We performed a systematic review of the available English literature published in the period 1 January 1997 to 31 August 2017 and focused on ARF in CAP. The database searches identified 189 articles—of these, only 29 were retained for data extraction. Of these 29 articles, 12 addressed ARF in CAP without discussing its ventilatory management, while 17 evaluated the ventilatory management of ARF in CAP. In the studies assessing the ventilatory management, the specific treatments addressed were: high-flow nasal cannula (HFNC) (n = 1), continuous positive airway pressure (n = 2), non-invasive ventilation (n = 9), and invasive mechanical ventilation (n = 5). When analyzed, non-invasive ventilation (NIV) success rates ranged from 20% to 76% and they strongly predicted survival, while NIV failure led to an increased risk of adverse outcome. In conclusion, ARF in CAP patients may require both ventilatory and non-ventilatory management. Further research is needed to better evaluate the use of NIV and HFNC in those patients. Alongside the prompt administration of antimicrobials, the potential use of steroids and the implementation of severity scores should also be considered.

2005 ◽  
Vol 33 (1) ◽  
pp. 101-111 ◽  
R. J. Boots ◽  
J. Lipman ◽  
R. Bellomo ◽  
D. Stephens ◽  
R. F. Heller

This study of ventilated patients investigated pneumonia risk factors and outcome predictors in 476 episodes of pneumonia (48% community-acquired pneumonia, 24% hospital-acquired pneumonia, 28% ventilator-associated pneumonia) using a prospective survey in 14 intensive care units within Australia and New Zealand. For community acquired pneumonia, mortality increased with immunosuppression (OR 5.32, CI 95% 1.58–17.99, P<0.01), clinical signs of consolidation (OR 2.43, CI 95% 1.09–5.44, P=0.03) and Sepsis-Related Organ Failure Assessment (SOFA) scores (OR 1.19, CI 95% 1.08–1.30, P<0.001) but improved if appropriate antibiotic changes were made within three days of intensive care unit admission (OR 0.42, CI 95% 0.20–0.86, P=0.02). For hospital-acquired pneumonia, immunosuppression (OR 6.98, CI 95% 1.16–42.2, P=0.03) and non-metastatic cancer (OR 3.78, CI 95% 1.20–11.93, P=0.02) were the principal mortality predictors. Alcoholism (OR 7.80, CI 95% 1.20–17.50, P<0.001), high SOFA scores (OR 1.44, CI 95% 1.20–1.75, P=0.001) and the isolation of “high risk” organisms including Pseudomonas aeruginosa, Acinetobacter spp, Stenotrophomonas spp and methicillin resistant Staphylococcus aureus (OR 4.79, CI 95% 1.43–16.03, P=0.01), were associated with increased mortality in ventilator-associated pneumonia. The use of non-invasive ventilation was independently protective against mortality for patients with community-acquired and hospital-acquired pneumonia (OR 0.35, CI 95% 0.18–0.68, P=0.002). Mortality was similar for patients requiring both invasive and non-invasive ventilation and non-invasive ventilation alone (21% compared with 20% respectively, P=0.56). Pneumonia risks and mortality predictors in Australian and New Zealand ICUs vary with pneumonia type. A history of alcoholism is a major risk factor for mortality in ventilator-associated pneumonia, greater in magnitude than the mortality effect of immunosuppression in hospital-acquired pneumonia or community-acquired pneumonia. Non-invasive ventilation is associated with reduced ICU mortality. Clinical signs of consolidation worsen, while rationalising antibiotic therapy within three days of ICU admission improves mortality for community-acquired pneumonia patients.

2017 ◽  
Vol 11 (1) ◽  
pp. 57
Enrico Cinque ◽  
Ines Maria Grazia Piroddi ◽  
Cornelius Barlascini ◽  
Alessandro Perazzo ◽  
Antonello Nicolini

Polymicrobial pneumonia may be caused by the combination of respiratory viruses, bacteria and fungi in a host. Colonization by <em>Streptococcus pneumoniae</em> was associated with increased risk of Intensive Care Unit admission or death in the setting of influenza infection, whereas the colonization by methicillin sensible <em>Staphylococcus aureus</em> co-infection was associated with severe disease and death in adults and children. The principal association of pathogens in community-acquired pneumonia (CAP) is bacteria and viral co-infection, and accounts approximately for 39% of microbiological diagnosed cases of CAP. The differential clinical diagnosis between a viral and a bacterial CAP is not easy: no clinical signs or radiological findings help the clinician to suspect to the diagnosis. Patients with polymicrobial infections are more likely to have underlying medical conditions and have more severe outcome. Severe respiratory failure and need of mechanical ventilation occur in several cases. Non invasive ventilation (NIV) use aims to avoid invasive mechanical ventilation. NIV treatment is controversial owing to high reported treatment failure. In this case series we report three cases of severe polymicrobial CAP: all of them required NIV with a good outcome.

2012 ◽  
Vol 38 (3) ◽  
pp. 458-466 ◽  
Andres Carrillo ◽  
Gumersindo Gonzalez-Diaz ◽  
Miquel Ferrer ◽  
Maria Elena Martinez-Quintana ◽  
Antonia Lopez-Martinez ◽  

2019 ◽  
Vol 37 (1) ◽  
pp. 167
Funda Sungur Biteker ◽  
Eda Özlek ◽  
Bülent Özlek ◽  
Oğuzhan Çelik ◽  
Cem Çil ◽  

2021 ◽  
Vol 10 (22) ◽  
pp. 1686-1691
Pampana Eshwaramma ◽  
Gaddam Ramulu Yadav ◽  
Vankayala Veena Reddy ◽  
Tarigopula Pramod Kumar ◽  
Mandapakala Gopala Krishna Murthy ◽  

BACKGROUND Community-Acquired Pneumonia (CAP) is defined as “an acute infection of the pulmonary parenchyma. The most important complication of CAP is Acute Respiratory Failure (ARF) and some of them may require Invasive Mechanical Ventilation (IMV) to manage hypoxia and hypoventilation along with appropriate antibiotic therapy. A number of studies, however, indicate that IMV is associated with high rates of serious complications and mortality in patients with ARF. For this reason Non-Invasive Ventilation (NIV) has been used for ARF of diverse aetiologies.The most important rationale for using NIV in early stages of respiratory failure is to decrease the workload on respiratory muscles and improve ventilation by applying positive airway pressure. This may help to overcome an episode of severe ARF without the need for MV. In this study we evaluated the efficacy of NIV in patients with ARF and compare the outcome of using NIV in CAP with ARF patients with and without comorbidities. METHODS This prospective observational study was done on 150 CAP patients in acute respiratory failure who received NIV. It was conducted in the Department of Respiratory Medicine in Gandhi Hospital, Secunderabad, for a period of one year and six months. A comparative analysis of the outcome of using NIV in CAP with ARF patients with and without co-morbidities was carried out. RESULTS In the current study 150 CAP patients with ARF who needed NIV, were treated initially with NIV, antibiotic therapy and other supportive measures as per the American Thoracic Society (ATS) guidelines 32. 95 (63.3 %) of 150 patients were continuously treated with NIV. Apart from these, 55 (36.7 %) patients required MV. In patients with continued NIV, 93 (98 %) recovered, remaining 2 died with sudden cardiac arrest. In patients who were gone for MV, 12 (22 %) survived. CONCLUSIONS Early intervention by NIV in CAP patients suffering from acute respiratory failure secondary to community acquired pneumonia was found to be successful in avoiding mechanical ventilation and its attendant morbidity and mortality31. Early intervention with NIV, identifying risk factors for NIV failure, addressing associated co-morbid conditions will go in a long way in effectively managing these patients by significantly minimizing the ICU and hospital stay. Patients with co-morbidities have more chances of NIV failures. Patients with co morbidities on NIV stayed significantly more number of days in the hospital than patients without co-morbidities. The current study suggests that co morbid patients require more monitoring as compared to patients without co morbidities on NIV. KEY WORDS Community-Acquired Pneumonia (CAP), Non-Invasive Ventilation (NIV), Mechanical Ventilation (MV), Acute Respiratory Failure (ARF), Arterial Blood Gas Analysis (ABG), Intensive Care Unit (ICU), Intubation

2014 ◽  
Vol 10 (1) ◽  
pp. 98-103 ◽  
Antonello Nicolini ◽  
Gianluca Ferraioli ◽  
Maura Ferrari-Bravo ◽  
Cornelius Barlascini ◽  
Mario Santo ◽  

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