Advertisement

Non-invasive ventilation in community acquired pneumonia

      We have greatly enjoyed reading the recently published article by Al-Rajhi et al. [
      • Al-Rajhi A.
      • Murad A.
      • Li P.Z.
      • Shahin J.
      Outcomes and predictors of failure of non-invasive ventilation in patients with community acquired pneumonia in the ED.
      ]. This retrospective cohort study was conducted among consecutive patients who received a diagnosis of community-acquired pneumonia (CAP) and needed ventilator support upon presentation to two tertiary care, university-affiliated EDs. The use of non-invasive ventilation (NIV) in severe acute respiratory failure due to CAP is controversial, and the risk factors for NIV failure in these patients are not well known. Previous reports have shown that, severity scores at admission and worse respiratory and cardiovascular function were associated with NIV failure [
      • Carrillo A.
      • Gonzalez-Diaz G.
      • Ferrer M.
      • Martinez-Quintana M.E.
      • Lopez-Martinez A.
      • Llamas N.
      • et al.
      Non-invasive ventilation in community-acquired pneumonia and severe acute respiratory failure.
      ,
      • Nicolini A.
      • Piroddi I.M.
      • Barlascini C.
      • Senarega R.
      Predictors of non-invasive ventilation failure in severe respiratory failure due to community acquired pneumonia.
      ]. Variables related with initial severity and worse clinical evolution in pneumonia, such as the need for vasoactive drugs, organ system dysfunction, and extension and worsening of radiological infiltrates, were also associated with failure [
      • Carrillo A.
      • Gonzalez-Diaz G.
      • Ferrer M.
      • Martinez-Quintana M.E.
      • Lopez-Martinez A.
      • Llamas N.
      • et al.
      Non-invasive ventilation in community-acquired pneumonia and severe acute respiratory failure.
      ,
      • Nicolini A.
      • Piroddi I.M.
      • Barlascini C.
      • Senarega R.
      Predictors of non-invasive ventilation failure in severe respiratory failure due to community acquired pneumonia.
      ]. Similar to previous studies, Al-Rajhi and colleagues found that NIV failure was associated with the absence of chronic obstructive airway disease, APACHE II score, the need for hemodynamic support and the number of CXR quadrants involved. However, we think that the present study has several limitations. First, the effectiveness of any treatment must be determined by a randomized controlled trial. In the absence of a control group, definitive conclusions cannot be drawn. Second, the study was conducted in two centres with major experience in the use of NIV, and therefore these results cannot be extrapolated to less trained and equipped hospitals. Third, no data were provided on the severity of acute respiratory failure in the patients included in the study (for instance: PaO2/FiO2). It is different to use NIV at an early stage of respiratory failure (for instance when the PaO2/ FiO2 ratio is <250) or a late stage of acute respiratory failure in patients presenting with intubation criteria. The lack of these data does not allow comparison of this study with previous studies dealing with hypoxaemic respiratory failure. Moreover, intensive care admission and intubation criteria were not standardized and delay time of intubation after NIV failure was not recorded.
      To read this article in full you will need to make a payment
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Emergency Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Al-Rajhi A.
        • Murad A.
        • Li P.Z.
        • Shahin J.
        Outcomes and predictors of failure of non-invasive ventilation in patients with community acquired pneumonia in the ED.
        Am J Emerg Med. 2018 Mar; 36: 347-351
        • Carrillo A.
        • Gonzalez-Diaz G.
        • Ferrer M.
        • Martinez-Quintana M.E.
        • Lopez-Martinez A.
        • Llamas N.
        • et al.
        Non-invasive ventilation in community-acquired pneumonia and severe acute respiratory failure.
        Intensive Care Med. 2012 Mar; 38: 458-466
        • Nicolini A.
        • Piroddi I.M.
        • Barlascini C.
        • Senarega R.
        Predictors of non-invasive ventilation failure in severe respiratory failure due to community acquired pneumonia.
        Tanaffos. 2014; 13: 20-28