Non-invasive positive pressure ventilation in pneumonia outside Intensive Care Unit: An Italian multicenter observational study

Brambilla, Anna Maria; Prina, Elena; Ferrari, Giovanni; Bozzano, Viviana; Ferrari, R.; Groff, Paolo; Petrelli, Giuseppina; Scala, Raffaele; Causin, Fabio; Noto, Paola; Bresciani, Emanuela; Voza, Antonio; Aliberti, Stefano; Cosentini, Roberto

doi:10.1016/j.ejim.2018.09.025

Cited by 16 publications

(16 citation statements)

References 24 publications

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“…The rate of CPAP failure (either intubation or death) in COVID-19 patients seems to be higher in our study compared with the one recently reported in a multicenter, observational study which enrolled non-COVID-19 pneumonia patients with comparable severity of hARF (44.6% versus 23%) [ 8 ]. Both intubation (21.7% versus 11%) and mortality (22.9% versus 12%) rates were also higher in COVID-19 pneumonia than non-COVID-19 pneumonia patients [ 8 ].…”

contrasting

confidence: 63%

“…Patients maintaining a PaO 2 :FiO 2 ratio >250 on Venturi mask with a FiO 2 <40% for at least 24 hours were considered successfully weaned from helmet CPAP. Qualitative and quantitative variables were The rate of CPAP failure (either intubation or death) in COVID-19 patients seems to be higher in our study compared with the one recently reported in a multicenter, observational study which enrolled non-COVID-19 pneumonia patients with comparable severity of hARF (44.6% VS. 23%) [8]. Both intubation (21.7% VS. 11%) and mortality (22.9% VS. 12%) rates were also higher in COVID-19 pneumonia than non-COVID-19 pneumonia patients [8].…”

Section: Textmentioning

confidence: 99%

“…Qualitative and quantitative variables were The rate of CPAP failure (either intubation or death) in COVID-19 patients seems to be higher in our study compared with the one recently reported in a multicenter, observational study which enrolled non-COVID-19 pneumonia patients with comparable severity of hARF (44.6% VS. 23%) [8]. Both intubation (21.7% VS. 11%) and mortality (22.9% VS. 12%) rates were also higher in COVID-19 pneumonia than non-COVID-19 pneumonia patients [8]. This finding can be explained by the complex phenomena behind the occurrence of the respiratory failure experienced by patients, which is often paralleled by local vascular micro-thrombosis, and, more importantly, by the absence of a treatment of proven efficacy [9].…”

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confidence: 99%

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Helmet CPAP treatment in patients with COVID-19 pneumonia: a multicentre cohort study

et al. 2020

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confidence: 63%

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confidence: 99%

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confidence: 99%

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Helmet CPAP treatment in patients with COVID-19 pneumonia: a multicentre cohort study

et al. 2020

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“…Furthermore, this systematic review highlighted that the failure of NIV in sustaining respiratory function led to an increased risk of adverse outcomes. Based on these data, a careful selection of candidates should be performed before starting NIV in order to provide adequate care to CAP patients [49,50].…”

Section: Discussionmentioning

confidence: 99%

Management of Acute Respiratory Failure Due to Community-Acquired Pneumonia: A Systematic Review

et al. 2019

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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.

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“…Brambilla et al [35] Italy "Do Not Intubate (DNI) order was defined as the decision of the physician in charge to withhold intubation and to use NIV as "ceiling" treatment considering the characteristics of the patients (e.g., extremely poor functional status prior on admission, very low predicted probability of hospital survival)"…”

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confidence: 99%

Do-not-intubate orders in patients with acute respiratory failure: a systematic review and meta-analysis

et al. 2019

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To assess the rates and variability of do-not-intubate orders in patients with acute respiratory failure. Methods: We conducted a systematic review of observational studies that enrolled adult patients with acute respiratory failure requiring noninvasive ventilation or high-flow nasal cannula oxygen from inception to 2019. Results: Twenty-six studies evaluating 10,755 patients were included. The overall pooled rate of do-not-intubate orders was 27%. The pooled rate of do-not-intubate orders in studies from North America was 14% (range 9-22%), from Europe was 28% (range 13-58%), and from Asia was 38% (range 9-83%), p = 0.001. Do-not-intubate rates were higher in studies with higher patient age and in studies where do-not-intubate decisions were made without reported patient/family input. There were no significant differences in do-not-intubate orders according to illness severity, observed mortality, malignancy comorbidity, or methodological quality. Rates of do-not-intubate orders increased over time from 9% in 2000-2004 to 32% in 2015-2019. Only 12 studies (46%) reported information about do-not-intubate decision-making processes. Only 4 studies (15%) also reported rates of do-not-resuscitate. Conclusions: One in four patients with acute respiratory failure (who receive noninvasive ventilation or high-flow nasal cannula oxygen) has a do-not-intubate order. The rate of do-not-intubate orders has increased over time. There is high inter-study variability in do-not-intubate rates-even when accounting for age and illness severity. There is high variability in patient/family involvement in do-not-intubate decision making processes. Few studies reported differences in rates of do-not-resuscitate and do-not-intubate-even though recovery is very different for acute respiratory failure and cardiac arrest.

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Non-invasive positive pressure ventilation in pneumonia outside Intensive Care Unit: An Italian multicenter observational study

Cited by 16 publications

References 24 publications

Helmet CPAP treatment in patients with COVID-19 pneumonia: a multicentre cohort study

Helmet CPAP treatment in patients with COVID-19 pneumonia: a multicentre cohort study

Management of Acute Respiratory Failure Due to Community-Acquired Pneumonia: A Systematic Review

Do-not-intubate orders in patients with acute respiratory failure: a systematic review and meta-analysis

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