The comparative effectiveness of noninvasive and invasive ventilation in patients with pneumonia

Stefan, Mihaela; Priya, Aruna; Pekow, Penelope S.; Lagu, Tara; Steingrub, Jay S.; Hill, Nicholas S.; Nathanson, Brian H.; Lindenauer, Peter K.

doi:10.1016/j.jcrc.2017.05.023

Cited by 38 publications

(27 citation statements)

References 40 publications

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“…We also explored the utility of NIV in patients with pneumonia. This has been controversial; prior studies have reported conflicting results, probably because of differences in clinical characteristics (pneumonia severity, age, or comorbidities) [ 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 ]. In patients with pneumonia, the median PaO 2 /FiO 2 ratio and the median SOFA score at NIV commencement were 155 and 5.…”

Section: Discussionmentioning

confidence: 99%

Factors for Predicting Noninvasive Ventilation Failure in Elderly Patients with Respiratory Failure

Park

Cho

Chang

et al. 2020

JCM

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Noninvasive ventilation (NIV) is useful when managing critically ill patients. However, it is not easy to apply to elderly patients, particularly those with pneumonia, due to the possibility of NIV failure and the increased mortality caused by delayed intubation. In this prospective observational study, we explored whether NIV was appropriate for elderly patients with pneumonia, defined factors that independently predicted NIV failure, and built an optimal model for prediction of such failure. We evaluated 78 patients with a median age of 77 years. A low PaCO2 level, a high heart rate, and the presence of pneumonia were statistically significant independent predictors of NIV failure. The predictive power for NIV failure of Model III (pneumonia, PaCO2 level, and heart rate) was better than that of Model I (pneumonia alone). Considering the improvement in parameters, patients with successful NIV exhibited significantly improved heart rates, arterial pH and PaCO2 levels, and patients with NIV failure exhibited a significantly improved PaCO2 level only. In conclusion, NIV is reasonable to apply to elderly patients with pneumonia, but should be done with caution. For the early identification of NIV failure, the heart rate and arterial blood gas parameters should be monitored within 2 h after NIV commencement.

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Section: Discussionmentioning

confidence: 99%

Factors for Predicting Noninvasive Ventilation Failure in Elderly Patients with Respiratory Failure

Park

Cho

Chang

et al. 2020

JCM

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“…By contrast, chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF) are common comorbidities in VOP and known to benefit from NIV in acute respiratory failure (2,10,11), possibly even in patients with pneumonia (2).…”

Section: Vopmentioning

confidence: 99%

“…Another concern is that studies assessing NIV in patients with pneumonia have yielded varying results (2,5,28,32), suggesting that NIV could even be harmful if applied to patients with a higher burden of non-respiratory organ dysfunctions or too hypoxemic (3, 4). Our subgroup analyses assessing effect modification did not suggest this was the case.…”

Section: Relationship With the Literaturementioning

confidence: 99%

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Non-invasive ventilation as the initial ventilatory strategy in very old critically ill patients with community-acquired pneumonia: a multicenter cohort study

Besen

Park

Ranzani

2020

Preprint

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Background The very old patients (≥ 80 years-old, VOP) comprise a subpopulation increasingly admitted to intensive care units (ICUs). Community-acquired pneumonia (CAP) is a common reason for admission and the best strategy of mechanical ventilation for respiratory failure in this scenario is not fully known. Methods Multicenter cohort study of VOPs admitted with CAP in need of invasive (IMV) or noninvasive (NIV) mechanical ventilation to 11 Brazilian ICUs from 2009 through 2012. We used logistic regression models to evaluate the association between ventilator strategy (NIV vs. IMV) and hospital mortality adjusting for confounding factors. We evaluated effect modification with interaction terms in pre-specified sub-groups. Results Of 369 VOPs admitted for CAP with respiratory failure, 232 (63%) received NIV and 137 (37%) received IMV as initial ventilatory strategy. IMV patients were sicker at ICU admission (median SOFA 8 vs. 4, p < 0.001). Hospital mortality was 114/232 (49%) for NIV and 90/137 (66%) for IMV. For the comparison NIV vs. IMV (reference), the crude odds ratio (OR) was 0.50 (95% CI, 0.33–0.78, p=0.002). This association was largely confounded by antecedent characteristics and non-respiratory SOFA (adjOR = 0.70, 95% CI, 0.41–1.20, p=0.196). The fully adjusted model, including Pao2/Fio2 ratio, pH and Paco2, yielded an adjOR of 0.81 (95% CI, 0.46–1.41, p=0.452). There was no strong evidence of effect modification among relevant subgroups, such as Pao2/Fio2 ratio ≤ 150 (p = 0.30), acute respiratory acidosis (p = 0.42) and non-respiratory SOFA ≥ 4 (p = 0.53). Conclusions NIV was not associated with lower hospital mortality when compared to IMV in critically ill VOP admitted with CAP, but there was no strong signal of harm from its use. The main confounders of this association were both the severity of respiratory dysfunction and of extra-respiratory organ failures.

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“… 4 For instance, in a recent study NIV was associated with increased survival among the subgroup of patients hospitalized with pneumonia who had COPD or heart failure. 19 Although current guidelines do not recommend NIV among patients with CAP, patients with COPD and heart failure may nonetheless obtain benefit from early and careful use of NIV in the acute care setting. 12 …”

Section: Patient Selectionmentioning

confidence: 99%

Non-invasive ventilation in the ED: Whom, When, How?

Göksu

Kılıç²,

İbze

2018

Turkish Journal of Emergency Medicine

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As emergency physicians, we encounter patients suffering from either hypoxemic and/or hypercarbic respiratory problems on a daily basis. A stepwise approach to solving this problem seems logical from an emergency medicine perspective.Current literature supports the notion that NIV decreases endotracheal intubation rates and, mortality in select patient populations. The key to the success of NIV is patient cooperation and support for the care givers.In this narrative review, non-invasive ventilation (NIV) is discussed in terms of modes of delivery, interface and patient selection, as well as practical considerations.

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The comparative effectiveness of noninvasive and invasive ventilation in patients with pneumonia

Cited by 38 publications

References 40 publications

Factors for Predicting Noninvasive Ventilation Failure in Elderly Patients with Respiratory Failure

Factors for Predicting Noninvasive Ventilation Failure in Elderly Patients with Respiratory Failure

Non-invasive ventilation as the initial ventilatory strategy in very old critically ill patients with community-acquired pneumonia: a multicenter cohort study

Non-invasive ventilation in the ED: Whom, When, How?

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