Outcomes and predictors of failure of non-invasive ventilation in patients with community acquired pneumonia in the ED - 10/03/18
Abstract |
Objective |
We set out to describe the use and analyze the predictors of non-invasive ventilation failure in patients with community-acquired pneumonia who receive non-invasive ventilation as first line ventilatory therapy in the emergency department.
Methods |
A retrospective cohort study was conducted among consecutive patients with community acquired pneumonia requiring ventilator support presenting to two tertiary care university-affiliated emergency departments. Multivariable logistic regression analysis was used to determine predictors of non-invasive ventilation failure at initiation of non-invasive ventilation and at two hours of non-invasive ventilation use;
Result |
After excluding patients with a do not resuscitate order status, 163 (74.8%) patients with community acquired pneumonia were initially treated with non-invasive ventilation on initial presentation to the emergency department. Non-invasive ventilation failure occurred in 50% of patients and was found to be associated with the absence of chronic obstructive airway disease, APACHE II score, the need for hemodynamic support and the number of CXR quadrants involved. Two-hour physiological parameters associated with non-invasive ventilation failure included higher respiratory rate, lower serum pH and the ongoing need of hemodynamic support.
Conclusion |
In conclusion, the use of non-invasive ventilation to support patients presenting to the emergency department with respiratory failure and community acquired pneumonia is common and is associated with a significant failure rate. Hemodynamic support is a strong predictor of failure. The selection of the appropriate patient and monitoring of physiological parameters while on NIV is crucial to ensure successful treatment.
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☆ | The authors have no conflict of interest to report. |
☆☆ | Authors contribution: AM and JS conceived and designed the study. AA, AM collected the data and help manage data quality along with JS. Data analysis was performed by JS and PZL. The manuscript was prepared by JS, AA with all authors contributing to its editing. JS takes responsibility for the manuscript as a whole. |
Vol 36 - N° 3
P. 347-351 - mars 2018 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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