Outcomes and predictors of failure of non-invasive ventilation in patients with community acquired pneumonia in the ED

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. A retrospective cohort study was conducted among consecutive...

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Bibliographic Details
Published in:The American journal of emergency medicine 2018-03, Vol.36 (3), p.347-351
Main Authors: Al-Rajhi, Amjad, Murad, Anwar, Li, P.Z., Shahin, Jason
Format: Article
Language:English
Subjects:
Blood
Cardiovascular disease
Chronic obstructive pulmonary disease
Clinical medicine
Clinical trials
Edema
Emergency medical care
Emergency medical services
Hospitals
Intensive care
Intubation
Kidney diseases
Lung diseases
Mechanical ventilation
Oxygen therapy
Patients
Physiology
Pneumonia
Regression analysis
Respiration
Respiratory failure
Respiratory rate
Respiratory therapy
Respiratory tract diseases
Ventilators
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Summary: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. 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; 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. 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.
ISSN:0735-6757
1532-8171
DOI:10.1016/j.ajem.2017.08.016