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Arch Bronconeumol. 2017 Sep;53(9):480-488. doi: 10.1016/j.arbres.2016.08.017. Epub 2016 Dec 14.

Role of First-Line Noninvasive Ventilation in Non-COPD Subjects With Pneumonia.

[Article in English, Spanish]

Author information

1
Servicio de Cuidados Intensivos, Hospital Son Llàtzer, Palma de Mallorca, Islas Baleares, España; Instituto de Investigación Sanitaria de Palma (IDISPA), Fundación de Investigación Sanitaria Illes Balears, Hospital Universitario Son Espases, Palma de Mallorca, Islas Baleares, España. Electronic address: grialp@gmail.com.
2
Servicio de Cuidados Intensivos, Hospital Son Llàtzer, Palma de Mallorca, Islas Baleares, España; Instituto de Investigación Sanitaria de Palma (IDISPA), Fundación de Investigación Sanitaria Illes Balears, Hospital Universitario Son Espases, Palma de Mallorca, Islas Baleares, España.
3
Servicio de Cuidados Intensivos, Hospital Comarcal d'Inca, Inca, Islas Baleares, España; Instituto de Investigación Sanitaria de Palma (IDISPA), Fundación de Investigación Sanitaria Illes Balears, Hospital Universitario Son Espases, Palma de Mallorca, Islas Baleares, España.

Abstract

INTRODUCTION:

The use of noninvasive ventilation (NIV) in non-COPD patients with pneumonia is controversial due to its high rate of failure and the potentially harmful effects when NIV fails. The purpose of the study was to evaluate outcomes of the first ventilatory treatment applied, NIV or invasive mechanical ventilation (MV), and to identify predictors of NIV failure.

METHODS:

Historical cohort study of 159 non-COPD patients with pneumonia admitted to the ICU with ventilatory support. Subjects were divided into 2 groups: invasive MV or NIV. Univariate and multivariate analyses with demographic and clinical data were performed. Analysis of mortality was adjusted for the propensity of receiving first-line invasive MV.

RESULTS:

One hundred and thirteen subjects received first-line invasive MV and 46 received first-line NIV, of which 27 needed intubation. Hospital mortality was 35, 37 and 56%, respectively, with no significant differences among groups. In the propensity-adjusted analysis (expressed as OR [95% CI]), hospital mortality was associated with age (1.05 [1.02-1.08]), SAPS3 (1.03 [1.00-1.07]), immunosuppression (2.52 [1.02-6.27]) and NIV failure compared to first-line invasive MV (4.3 [1.33-13.94]). Compared with invasive MV, NIV failure delayed intubation (p=.004), and prolonged the length of invasive MV (p=.007) and ICU stay (p=.001). NIV failure was associated with need for vasoactive drugs (OR 7.8 [95% CI, 1.8-33.2], p=.006).

CONCLUSIONS:

In non-COPD subjects with pneumonia, first-line NIV was not associated with better outcome compared with first-line invasive MV. NIV failure was associated with longer duration of MV and hospital stay, and with increased hospital mortality. The use of vasoactive drugs predicted NIV failure.

KEYWORDS:

Cuidados intensivos; Intensive care; Mortalidad; Mortality; Neumonía; Noninvasive ventilation; Pneumonia; Propensity score; Ventilación no invasiva; Índice de propensión

PMID:
27988055
DOI:
10.1016/j.arbres.2016.08.017
[Indexed for MEDLINE]
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